Beta

OpenPayer Beta

Summary & Overview

CPT 01472: Anesthesia for Achilles Tendon Repair

CPT code 01472 covers anesthesia services for surgical repair of a ruptured Achilles tendon, with or without graft, in the lower leg, ankle, and foot. This code is significant for both clinical and billing purposes, as it defines the scope of anesthesia care required for these complex orthopedic procedures. The code is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage across commercial insurance plans.

Readers will gain insight into the clinical context of Achilles tendon repair, the role of anesthesia in these procedures, and the coding specifics that impact reimbursement and policy. The publication provides benchmarks and policy updates relevant to anesthesia billing, as well as an overview of associated modifiers and taxonomies. Understanding CPT code 01472 is essential for healthcare professionals, billing specialists, and policy analysts seeking clarity on anesthesia coding for lower extremity tendon repairs. The article also highlights related codes and common diagnoses, offering a comprehensive view of the coding landscape for these procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01472anesthesiaAchilles tendon repairorthopedic surgerymedical billingprocedure codingclinical contextpolicy updatesbenchmarkslower extremity procedures

CPT Code Overview

CPT code 01472 is designated for anesthesia services provided during procedures involving the nerves, muscles, tendons, and fascia of the lower leg, ankle, and foot, specifically for the repair of a ruptured Achilles tendon, with or without graft. This code is used to capture the complexity and clinical requirements of anesthesia care during these surgical interventions. The service type is anesthesia, which encompasses the administration and monitoring of anesthetic agents to ensure patient comfort and safety throughout the procedure. Typical site of service information is not specified in available sources.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult presenting with a ruptured Achilles tendon, often following a sports injury or traumatic event. The patient may experience sudden pain in the lower leg, difficulty walking, and swelling near the ankle. Surgical repair of the ruptured Achilles tendon is indicated, which may involve grafting. During the procedure, anesthesia services are provided to ensure patient comfort and immobility. The clinical workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative recovery. Anesthesia is typically administered by an anesthesiologist, anesthesiology assistant, or certified registered nurse anesthetist.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when anesthesia is provided with continuous monitoring but not general anesthesia.
- QX: CRNA service with medical direction by a physician. Used when a certified registered nurse anesthetist provides anesthesia under physician supervision.
Provider Taxonomies:

Taxonomy Code Specialty Name
207L00000X Anesthesiology
207RA0401X Anesthesiology Assistant
367500000X Certified Registered Nurse Anesthetist

Taxonomy Code	Specialty Name
`207L00000X`	Anesthesiology
`207RA0401X`	Anesthesiology Assistant
`367500000X`	Certified Registered Nurse Anesthetist

These taxonomies represent the specialties qualified to provide anesthesia services for this procedure.

Related Diagnoses

S82.101A: Fracture of upper end of right tibia, initial encounter for closed fracture
- Relevant for patients presenting with lower leg trauma, which may be associated with Achilles tendon injury.
S82.102A: Fracture of upper end of left tibia, initial encounter for closed fracture
- Indicates left lower leg trauma, potentially related to the clinical scenario requiring Achilles tendon repair.
M25.571: Pain in right ankle and joints of right foot
- Represents symptoms that may prompt evaluation for tendon rupture or injury.
M25.572: Pain in left ankle and joints of left foot
- Similar to M25.571, this code covers pain symptoms relevant to Achilles tendon pathology.
S93.401A: Sprain of unspecified ligament of right ankle, initial encounter
- Indicates acute injury to the ankle, which may coexist with or lead to Achilles tendon rupture.

Each diagnosis code reflects conditions commonly associated with or leading to the need for Achilles tendon repair and anesthesia services.

Related CPT Codes

01470: Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified.
- Used for anesthesia services in similar procedures on the lower leg, ankle, and foot that are not specifically described by other codes.
- May be used as an alternative to 01472 when the procedure is not Achilles tendon repair.
01474: Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (eg, Strayer procedure).
- Used for anesthesia during gastrocnemius recession procedures, which are distinct from Achilles tendon repair.
- Not commonly used together with 01472, but may be selected based on the specific surgical intervention.

These codes are related by anatomical site and type of procedure, serving as alternatives or for different surgical indications.

Free Report

See how your rates compare to the market.

Get a free custom competitive market analysis.

Free Report

See how your rates compare to the market.

Get a free custom competitive market analysis.

Beta

OpenPayer Beta

Summary & Overview

CPT 01472: Anesthesia for Achilles Tendon Repair

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when anesthesia is provided with continuous monitoring but not general anesthesia.
- QX: CRNA service with medical direction by a physician. Used when a certified registered nurse anesthetist provides anesthesia under physician supervision.
Provider Taxonomies:

Taxonomy Code Specialty Name
207L00000X Anesthesiology
207RA0401X Anesthesiology Assistant
367500000X Certified Registered Nurse Anesthetist

Taxonomy Code	Specialty Name
`207L00000X`	Anesthesiology
`207RA0401X`	Anesthesiology Assistant
`367500000X`	Certified Registered Nurse Anesthetist

These taxonomies represent the specialties qualified to provide anesthesia services for this procedure.

Related Diagnoses

S82.101A: Fracture of upper end of right tibia, initial encounter for closed fracture
- Relevant for patients presenting with lower leg trauma, which may be associated with Achilles tendon injury.
S82.102A: Fracture of upper end of left tibia, initial encounter for closed fracture
- Indicates left lower leg trauma, potentially related to the clinical scenario requiring Achilles tendon repair.
M25.571: Pain in right ankle and joints of right foot
- Represents symptoms that may prompt evaluation for tendon rupture or injury.
M25.572: Pain in left ankle and joints of left foot
- Similar to M25.571, this code covers pain symptoms relevant to Achilles tendon pathology.
S93.401A: Sprain of unspecified ligament of right ankle, initial encounter
- Indicates acute injury to the ankle, which may coexist with or lead to Achilles tendon rupture.

Each diagnosis code reflects conditions commonly associated with or leading to the need for Achilles tendon repair and anesthesia services.

Related CPT Codes

01470: Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified.
- Used for anesthesia services in similar procedures on the lower leg, ankle, and foot that are not specifically described by other codes.
- May be used as an alternative to 01472 when the procedure is not Achilles tendon repair.
01474: Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (eg, Strayer procedure).
- Used for anesthesia during gastrocnemius recession procedures, which are distinct from Achilles tendon repair.
- Not commonly used together with 01472, but may be selected based on the specific surgical intervention.

These codes are related by anatomical site and type of procedure, serving as alternatives or for different surgical indications.

National Reimbursement Benchmarks

For CPT code 01472, national mean rates among commercial payers (BUCA average) are $163.73, which are substantially higher than UnitedHealth Group's mean rate of $65.58. Blue Cross Blue Shield and Cigna report the highest mean rates at $286.75 and $298.29, respectively, while Aetna's mean rate is $231.39.

Rate dispersion varies significantly across payers. Blue Cross Blue Shield has the tightest range between the 25th and 75th percentiles ($153.25), indicating more consistent reimbursement. Cigna and Aetna show the widest dispersions, with Cigna's range at $345.00 and Aetna's at $354.00, reflecting greater variability in rates. UnitedHealth Group's range is much narrower at $25.08.

The table and chart below present a detailed breakdown of national benchmarks for each payer.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska displays a significant spread in reimbursement rates for CPT code 01472, particularly among Blue Cross Blue Shield and BUCA, where the difference between the 75th and 25th percentiles exceeds $95 and $170, respectively. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal rate variation, with their 25th, 50th, and 75th percentiles clustered closely together, indicating limited negotiation or variation in rates for these payers.

Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are substantially higher, while Cigna and UnitedHealth Group are notably lower. The table and chart below present the full breakdown of payer-specific reimbursement benchmarks for Alaska.

Key Insights for Alaska

Blue Cross Blue Shield offers the highest mean reimbursement rate for CPT 01472 in Alaska at $327.72, while UnitedHealth Group is the lowest at $74.78.
Cigna and UnitedHealth Group both have narrow rate spreads, with 25th and 75th percentiles differing by less than $10.
Alaska's mean rates for most payers, especially Blue Cross Blue Shield and BUCA, are notably higher than their respective national averages.

Related Codes

01610

CPT 01610: Anesthesia for Knee Joint Procedures, Unspecified

01622

CPT 01622: Anesthesia for Diagnostic Shoulder Arthroscopy

01340

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

01670

CPT 01670: Anesthesia for Procedures on the Shoulder and Axilla

01272

CPT 01272: Anesthesia for Upper Leg Vascular Procedures (Femoral Artery)

01654

CPT 01654: Anesthesia for Lower Leg Procedures, Not Otherwise Specified

01484

CPT 01484: Anesthesia for Osteotomy or Osteoplasty of Tibia and/or Fibula

01392

CPT 01392: Anesthesia for Knee Area Surgery

01480

CPT 01480: Anesthesia for Lower Leg Bone Surgery

01360

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

Showing 1–10 of 74

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Free Report

See how your rates compare to the market.

Get a free custom competitive market analysis.

Free Report

See how your rates compare to the market.

Get a free custom competitive market analysis.

National Reimbursement Benchmarks

The table and chart below present a detailed breakdown of national benchmarks for each payer.

National Mean Rates for CPT Code `01472` by Payer

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Mean Reimbursement Rates by Payer in Alaska for CPT 01472

Key Insights for Alaska

Blue Cross Blue Shield offers the highest mean reimbursement rate for CPT 01472 in Alaska at $327.72, while UnitedHealth Group is the lowest at $74.78.
Cigna and UnitedHealth Group both have narrow rate spreads, with 25th and 75th percentiles differing by less than $10.
Alaska's mean rates for most payers, especially Blue Cross Blue Shield and BUCA, are notably higher than their respective national averages.