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

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Summary & Overview

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

CPT code 01654 represents anesthesia for procedures on the lower leg, below the knee, not otherwise specified. This code is significant for hospitals and anesthesia providers nationwide, as it ensures proper billing and documentation for a variety of lower leg surgical interventions. The code is most frequently used in outpatient hospital settings, reflecting the trend toward ambulatory surgical care.

Major national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Understanding payer policies and coverage for CPT code 01654 is crucial for providers and billing teams to maintain compliance and optimize reimbursement.

This publication offers a comprehensive overview of CPT code 01654, including its clinical context, typical site of service, and related coding benchmarks. Readers will gain insights into payer coverage, policy updates, and the role of anesthesia in lower leg procedures. The summary also highlights common modifiers and associated taxonomies relevant to anesthesiology, providing a clear framework for accurate coding and billing. By reviewing this information, stakeholders can stay informed about national trends and requirements for anesthesia services in lower leg procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01654anesthesiologyoutpatient hospitallower leg proceduresmedical billinganesthesia codingclinical documentationprocedure codespolicy updates

CPT Code Overview

CPT code 01654 is used to report anesthesia services for procedures performed on the lower leg, specifically below the knee, when the procedure is 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 lower leg procedures, ensuring proper reimbursement and compliance with national standards.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult presenting to the outpatient hospital with acute or chronic conditions affecting the lower leg, below the knee. Examples include a closed fracture of the upper end of the right tibia, pain or contracture in the right knee, unilateral primary osteoarthritis, or a sprain of the anterior cruciate ligament. The patient is scheduled for a surgical or diagnostic procedure on the lower leg, below the knee, requiring anesthesia services. An anesthesiologist, certified registered nurse anesthetist, or anesthesiology assistant provides anesthesia care, ensuring patient comfort and safety throughout the procedure. The workflow includes pre-anesthesia assessment, administration of anesthesia, intraoperative monitoring, and post-anesthesia recovery.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when anesthesia is provided in a manner that allows the patient to remain responsive and breathing independently.
- QX: CRNA service with medical direction by a physician. Used when a certified registered nurse anesthetist provides anesthesia under the supervision of a physician.
Provider Taxonomies:

Code Specialty Name

National Reimbursement Benchmarks

National mean rates for CPT code 01654 show significant variation across commercial payers. Cigna has the highest mean rate at $454.82, followed by Blue Cross Blue Shield at $374.99, while UnitedHealth Group is notably lower at $65.63. The BUCA average commercial mean rate stands at $174.43. Medicare rates are not available in the input for comparison.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Cigna ($603.79) and Aetna ($410.00), indicating substantial variability in contracted rates. Blue Cross Blue Shield ($208.12) and BUCA ($220.00) show moderate dispersion, while UnitedHealth Group has the tightest range at $25.17, reflecting more consistent rates.

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

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska exhibits a wide range in reimbursement rates for CPT code 01654, with Blue Cross Blue Shield offering the highest mean rate at $509.76 and UnitedHealth Group the lowest at $74.78. The rate spread is particularly notable for Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles ($583.75 minus $420.60) is $163.15, indicating significant variability. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal spread, with their 25th, 50th, and 75th percentiles tightly grouped around $72–$93.

Compared to national benchmarks, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably higher, while Cigna and UnitedHealth Group are below their respective national averages. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting these disparities and the overall landscape for CPT code 01654.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 01654 in Alaska, with a mean rate of $509.76, while UnitedHealth Group is the lowest at $74.78.
The rate spread is substantial, with BCBS's 75th percentile ($583.75) far exceeding Aetna, Cigna, and UnitedHealth Group, whose 75th percentiles cluster around $72–$93.
Compared to national averages, BCBS and BUCA pay significantly more in Alaska, while Cigna and UnitedHealth Group pay less than their national mean rates.

Related Codes

01430

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

01522

CPT 01522: Anesthesia for Total Knee Arthroplasty

01215

CPT 01215: Anesthesia for Revision of Total Hip Arthroplasty

01232

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

01680

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

01320

CPT 01320: Anesthesia for Knee and Popliteal Area Procedures

01442

CPT 01442: Anesthesia for Knee and Popliteal Area Procedures

01710

CPT 01710: Anesthesia for Upper Arm and Elbow Procedures

01756

CPT 01756: Anesthesia for Open or Arthroscopic Elbow Procedures

01470

CPT 01470: Anesthesia for Lower Leg, Ankle, and Foot Procedures

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