CPT 01392 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 01392: Anesthesia for Knee Area Surgery

CPT code 01392 represents anesthesia services provided for knee area surgery, a critical component in orthopedic and surgical care. This code is widely recognized across the United States and is essential for accurate billing and reimbursement in hospital settings. The analysis includes coverage details from major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, offering a comprehensive overview of payer policies and billing practices.

Readers will gain insight into the clinical context of knee area anesthesia, typical sites of service, and relevant coding benchmarks. The publication also highlights common modifiers used in conjunction with 01392, associated provider taxonomies, and ICD-10 diagnoses frequently linked to knee surgeries. Additionally, related CPT codes are discussed to provide a broader understanding of anesthesia coding for knee procedures. This summary serves as a resource for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on anesthesia coding standards, payer coverage, and clinical documentation requirements for knee area surgery.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01392anesthesiologyknee surgeryinpatient hospitalmedical billinganesthesia codingorthopedic proceduresclinical documentationpolicy updateICD-10

CPT Code Overview

CPT code 01392 is used to report anesthesia services for knee area surgery. This code falls under the anesthesiology service type and is typically performed in an inpatient hospital setting (Place of Service 21). The procedure involves the administration and management of anesthesia to ensure patient comfort and safety during surgical interventions in the knee area.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult admitted to an inpatient hospital for knee surgery, such as a total knee replacement or repair of knee structures. The patient may have a diagnosis of unilateral primary osteoarthritis or may be presenting for revision of a previously implanted artificial knee joint. The anesthesiology team provides anesthesia services for the surgical procedure, ensuring patient comfort and safety throughout the operation. The clinical workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative care.

Coding Specifications

Modifier Code	Description	When Used
`QS`	Monitored anesthesia care service	Used when anesthesia is provided as monitored anesthesia care rather than general anesthesia.
`QX`	CRNA service with medical direction by a physician	Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.

Associated Provider Taxonomies:

National Reimbursement Benchmarks

National mean rates for CPT code 01392 show that BUCA (average commercial) is at $155.20, while Medicare rates are not available in the input. Among the commercial payers, Aetna and Cigna have the highest mean rates, at $259.91 and $248.89 respectively, while UnitedHealth Group is notably lower at $65.46.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Aetna exhibits the widest spread ($316.26), indicating substantial variability in contracted rates. Cigna also shows a wide range ($258.00). In contrast, UnitedHealth Group has the tightest range ($24.83), suggesting more consistent rates nationally. Blue Cross Blue Shield's range is moderate at $99.60, and BUCA's is $152.67.

The table and chart below present the full breakdown of national benchmarks for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a wide rate spread for CPT code 01392, particularly among Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $72.70 ($298.50 minus $225.80). Cigna and UnitedHealth Group show much narrower spreads, with only $8.00 and $3.00 respectively, indicating less variability in their reimbursement rates. Compared to national averages, Alaska's mean rates for most payers are higher, except for Cigna and UnitedHealth Group, which are notably lower than their national benchmarks.

The table and chart below present the full breakdown of mean rates and percentile distributions for each payer in Alaska, highlighting the significant differences in reimbursement levels across the market.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 01392 in Alaska, with a mean rate of $267.05.
UnitedHealth Group offers the lowest mean rate at $74.78, significantly below both the state and national averages.
Cigna's mean rate in Alaska ($89.33) is notably lower than its national mean ($248.89), indicating a substantial deviation.

CPT 01320: Anesthesia for Knee and Popliteal Area Procedures

01404-ANESTHESIA-FOR-PROCEDURES-ON-THE-KNEE-AND-POPLITEAL

CPT 01404: Anesthesia for Knee and Popliteal Area Procedures

01442-UNDER-ANESTHESIA-FOR-PROCEDURES-ON-THE-KNEE-AND-POPLITEAL

CPT 01442: Anesthesia for Knee and Popliteal Area Procedures

01440-ANESTHESIA-FOR-PROCEDURES-ON-ARTERIES-OF-KNEE-AND-POPLITEAL

CPT 01440: Anesthesia for Knee and Popliteal Artery Procedures

01432-ANESTHESIA-FOR-PROCEDURES-ON-VEINS-OF-KNEE-AND-POPLITEAL

CPT 01432: Anesthesia for Knee and Popliteal Vein Arteriovenous Fistula Procedures

01390-UNDER-ANESTHESIA-FOR-PROCEDURES-ON-THE-KNEE-AND-POPLITEAL

CPT 01390: Anesthesia for Closed Procedures of the Upper Tibia, Fibula, or Patella

01400-ANESTHESIA-FOR-OPEN-OR-SURGICAL-ARTHROSCOPIC-PROCEDURES-ON

CPT 01400: Anesthesia for Knee Arthroscopic or Open Procedures

01444-ANESTHESIA-FOR-PROCEDURES-ON-ARTERIES-OF-KNEE-AND-POPLITEAL

CPT 01444: Anesthesia for Knee and Popliteal Artery Procedures

01430-ANESTHESIA-FOR-PROCEDURES-ON-KNEE-JOINT-NOT-OTHERWISE

CPT 01430: Anesthesia for Knee Joint Procedures, Not Otherwise Specified

01340-ANESTHESIA-FOR-ALL-CLOSED-PROCEDURES-ON-LOWER-ONETHIRD-OF

CPT 01340: Anesthesia for Closed Procedures on Lower Third of Femur

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Related CPT Codes

CPT Code	Description	Clinical Relationship
`01360`	ANESTH, KNEE AREA SURGERY	Similar to `01392`, used for anesthesia during knee area surgeries; may be used as an alternative depending on procedure specifics.
`01380`	ANESTH, KNEE JOINT PROCEDURE	Used for anesthesia during procedures specifically involving the knee joint; often related to joint repair or replacement.
`01382`	ANESTH, KNEE ARTHROSCOPY	Used for anesthesia during arthroscopic procedures of the knee; commonly used when minimally invasive techniques are employed.
`01390`	ANESTH, KNEE AREA PROCEDURE	Used for anesthesia during other knee area procedures; may be used together or as alternatives based on surgical approach.

These codes are related to 01392 and may be selected based on the specific surgical procedure performed on the knee. Some may be used together in complex cases, while others serve as alternatives for different types of knee surgeries.

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Summary & Overview

CPT 01392: Anesthesia for Knee Area Surgery

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes