CPT 01404: Anesthesia for Knee and Popliteal Area Procedures - OpenPayer

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Summary & Overview

CPT 01404: Anesthesia for Knee and Popliteal Area Procedures

CPT code 01404 is a critical billing code for anesthesia services provided during surgical procedures on the knee and popliteal area. This code is widely used across inpatient hospital settings, reflecting its importance in orthopedic and surgical care nationwide. The publication covers major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, offering a comprehensive overview of payer coverage and policy considerations for this anesthesia service.

Readers will gain insight into the clinical context of CPT 01404, including its role in supporting knee surgeries such as arthroplasty, arthroscopy, and ligament repair. The summary includes benchmarks for utilization, policy updates, and relevant modifiers that impact billing and reimbursement. Additionally, the publication highlights associated provider taxonomies and common ICD-10 diagnoses linked to knee procedures, providing a well-rounded perspective for stakeholders in anesthesia, orthopedics, and hospital administration.

This resource is designed to inform healthcare professionals, billing specialists, and policy analysts about the nuances of anesthesia coding for knee and popliteal procedures, ensuring clarity in documentation and alignment with payer requirements. The analysis also references related CPT codes to contextualize the broader landscape of knee surgery billing and reimbursement.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01404anesthesiaknee procedurespopliteal areainpatient hospitalorthopedic surgerymedical billingprocedure codingpolicy updatesclinical benchmarks

CPT Code Overview

CPT 01404 is used to report anesthesia services for procedures performed on the knee and popliteal area. This code is specifically designated for anesthesia care provided during surgical interventions involving these anatomical regions. The service type is anesthesia, and the typical site of service is an inpatient hospital setting (POS 21). This code is essential for accurately documenting and billing anesthesia services related to knee and popliteal procedures, ensuring proper reimbursement and compliance with medical billing standards.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult admitted to an inpatient hospital for a surgical procedure on the knee or popliteal area. The patient may have a diagnosis such as unilateral primary osteoarthritis of the knee or may be undergoing revision surgery for a previously placed artificial knee joint. The clinical workflow includes preoperative assessment, administration of anesthesia by an anesthesiology physician or a certified registered nurse anesthetist (CRNA), and monitoring throughout the procedure. The anesthesia service is coded with 01404 for procedures specifically targeting the knee and popliteal region.

Coding Specifications

Common Modifiers:

Modifier Code	Description
`AA`	Anesthesia services performed personally by anesthesiologist
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures
`QX`	CRNA service with medical direction by a physician

National Reimbursement Benchmarks

National mean rates for CPT code 01404 show that BUCA (average commercial) pays $129.12, while Medicare rates are not available in the input. Among individual commercial payers, Cigna has the highest mean rate at $299.57, followed by Blue Cross Blue Shield at $253.44, Aetna at $165.66, and UnitedHealth Group at $65.59.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Cigna exhibits the widest spread ($344.73), indicating substantial variability in contracted rates. Aetna also shows a large range ($267.00), while Blue Cross Blue Shield's rates are more tightly clustered ($136.00). UnitedHealth Group has the tightest range ($25.08), suggesting more consistent reimbursement levels.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska displays a significant rate spread for CPT code 01404, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $95.40 ($370.00 minus $274.60). BUCA also shows a notable spread of $155.33 ($297.00 minus $141.67). In contrast, Aetna and UnitedHealth Group have minimal spreads, with all percentiles clustered closely around $72.00–$75.00, indicating limited variability in their reimbursement rates.

Compared to national averages, most payers in Alaska—especially Blue Cross Blue Shield and BUCA—offer substantially higher mean rates. Cigna and UnitedHealth Group, however, reimburse at lower mean rates than their national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska for CPT code 01404.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 01404 in Alaska, with a mean rate of $327.91.
UnitedHealth Group offers the lowest mean rate at $74.78.
Mean rates for most payers in Alaska are higher than their respective national averages, except for Cigna and UnitedHealth Group, which are lower.

Related Codes

01214

CPT 01214: Anesthesia for Total Hip Arthroplasty

01482

CPT 01482: Anesthesia for Radical Resection of Lower Leg, Ankle, and Foot

01234

CPT 01234: Anesthesia for Radical Resection of Upper Femur

01200

CPT 01200: Anesthesia for Upper Leg Procedures (Except Knee)

01232

CPT 01232: Anesthesia for Upper Leg Procedures (Except Knee)

01360

CPT 01360: Anesthesia for Procedures on the Knee and Popliteal Area

01730

CPT 01730: Anesthesia for Closed Procedures on Humerus and Elbow

01380

CPT 01380: Anesthesia for Knee Arthroscopy Procedures

01320

CPT 01320: Anesthesia for Knee and Popliteal Area Procedures

01652

CPT 01652: Anesthesia for Axillary-Brachial Aneurysm Procedures

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