CPT 01620: Anesthesia for Knee and Popliteal Area Procedures - OpenPayer

Beta

OpenPayer Beta

Summary & Overview

CPT 01620: Anesthesia for Knee and Popliteal Area Procedures

CPT code 01620 represents anesthesia for procedures on the knee and/or popliteal area that are not otherwise specified. This code is significant for hospitals and anesthesia providers, as it covers a broad range of knee interventions where specific anesthesia codes do not apply. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, making it relevant for providers seeking coverage and reimbursement across diverse patient populations.

The publication provides a comprehensive overview of CPT 01620, including payer coverage, typical clinical scenarios, and associated billing practices. Readers will gain insights into benchmarks for utilization, policy updates affecting anesthesia services, and the clinical context in which this code is applied. The analysis also highlights common modifiers used in conjunction with this code, relevant provider taxonomies, and associated ICD-10 diagnoses that frequently justify its use. Additionally, related CPT codes are discussed to clarify distinctions and support accurate coding.

This summary equips healthcare professionals, billing specialists, and policy analysts with the information needed to understand the scope and application of CPT 01620 in outpatient hospital settings, supporting compliance and operational efficiency.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01620anesthesiologyknee proceduresoutpatient hospitalmedical billinganesthesia codingclinical documentationpolicy updatesICD-10 diagnosesprocedure benchmarks

CPT Code Overview

CPT 01620 is used to report anesthesia services for procedures performed on the knee and/or popliteal area that are not otherwise specified. This code falls under the anesthesiology service type and is most commonly utilized in the outpatient hospital setting (Place of Service 22). The code is essential for accurately documenting and billing anesthesia care provided during a range of knee-related procedures, ensuring proper reimbursement and compliance with national standards.

Clinical & Coding Specifications

Clinical Context

A patient presents to the outpatient hospital with knee pain and functional limitation due to a condition such as unilateral primary osteoarthritis or chronic instability. The orthopedic surgeon schedules a procedure on the knee or popliteal area that does not fall under a more specific anesthesia code. The anesthesiology team evaluates the patient preoperatively, confirms the need for anesthesia, and provides anesthesia services during the procedure. The anesthesia may be administered by a physician anesthesiologist, a certified registered nurse anesthetist (CRNA), or an anesthesiology assistant, depending on staffing and medical direction. The procedure is performed in an outpatient hospital setting (Place of Service 22), and anesthesia is monitored throughout the surgical intervention. Documentation includes the anesthesia start and stop times, the type of anesthesia provided, and any relevant modifiers indicating the nature of the service or provider involvement.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care (MAC) rather than general anesthesia.
- QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia services under the medical direction of a physician anesthesiologist.
Provider Taxonomies:

National Reimbursement Benchmarks

National mean rates for CPT code 01620 show that Cigna and Blue Cross Blue Shield have the highest average reimbursement, at $248.87 and $215.62 respectively. UnitedHealth Group is notably lower, with a mean rate of $65.52. The BUCA (average commercial) mean rate stands at $119.48, which is significantly higher than typical Medicare rates, though Medicare data is not available in the input for this code.

Rate dispersion varies considerably across payers. Blue Cross Blue Shield has the tightest spread, with a difference of $102.78 between its 75th and 25th percentiles, indicating more consistent rates. Cigna shows the widest dispersion, with a $258.00 gap, reflecting greater variability in reimbursement. UnitedHealth Group and BUCA also have relatively narrow ranges, at $24.80 and $125.49 respectively.

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

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska demonstrates a substantial rate spread for CPT code 01620 across commercial payers. Blue Cross Blue Shield shows the widest spread, with a 75th percentile rate of $298.50 and a 25th percentile rate of $225.80, resulting in a $72.70 difference. BUCA also exhibits a notable spread of $135.78 between its 75th and 25th percentiles. In contrast, Aetna and UnitedHealth Group have minimal spreads, with all percentile values clustered closely around $72.00–$75.00, indicating limited rate variability.

Compared to national averages, Alaska's mean rates for most payers are significantly higher, particularly for Blue Cross Blue Shield and BUCA. The table and chart below present the full breakdown of payer-specific reimbursement rates in Alaska, highlighting these differences and the range of payment levels across the state.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 01620 in Alaska, with a mean rate of $267.01.
UnitedHealth Group offers the lowest mean rate at $74.78.
Alaska's mean rates for most payers are notably higher than national averages, especially for Blue Cross Blue Shield and BUCA.

Related Codes

01462

CPT 01462: Anesthesia for Open Bone Procedures of Lower Leg/Ankle/Foot

01340

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

01392

CPT 01392: Anesthesia for Knee Area Surgery

01260

CPT 01260: Anesthesia for Veins of Upper Leg Including Exploration

01656

CPT 01656: Anesthesia for Axillary to Femoral Artery Bypass Graft

01404

CPT 01404: Anesthesia for Knee and Popliteal Area Procedures

01744

CPT 01744: Anesthesia for Total Knee Arthroplasty

01680

CPT 01680: Anesthesia for Shoulder Cast Application, Removal, or Repair

01230

CPT 01230: Anesthesia for Open Procedures Involving Upper Two-Thirds of Femur

01782

CPT 01782: Anesthesia for Lower Leg, Ankle, and Foot Procedures

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.