CPT 01742: Anesthesia for Upper Arm and Elbow Procedures - OpenPayer

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Summary & Overview

CPT 01742: Anesthesia for Upper Arm and Elbow Procedures

CPT code 01742 represents anesthesia for procedures on the upper arm and elbow, a critical component in surgical care for these anatomical regions. This code is widely recognized across the United States and is used by anesthesiology professionals to ensure proper billing and documentation for anesthesia services provided during upper arm and elbow surgeries. The code is relevant in both ambulatory surgery centers and hospital operating rooms, reflecting its broad applicability in clinical practice.

Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, cover services billed under CPT code 01742. Understanding the nuances of this code is important for healthcare organizations, billing professionals, and clinicians seeking to stay current with policy updates, reimbursement benchmarks, and clinical context. This publication provides an overview of payer coverage, typical sites of service, and related clinical information, offering readers a comprehensive look at how CPT code 01742 is utilized in the healthcare system. Key topics include payer policies, common modifiers, associated taxonomies, and relevant ICD-10 diagnoses, equipping stakeholders with the information needed to navigate the evolving landscape of anesthesiology billing and compliance.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01742anesthesiologyupper arm procedureselbow proceduressurgery centerhospital operating roommedical billingclinical documentationpolicy updatesprocedure coding

CPT Code Overview

CPT code 01742 is used to report anesthesia services for procedures performed on the upper arm and elbow. This code falls under the anesthesiology service type and is typically utilized in settings such as a surgery center or hospital operating room (place of service 24 or 21). The code is essential for accurately documenting and billing anesthesia care provided during surgical interventions involving the upper arm and elbow.

Clinical & Coding Specifications

Clinical Context

A patient presents to a surgery center or hospital operating room for a procedure involving the upper arm or elbow. The patient may have conditions such as chronic instability of the knee or primary osteoarthritis, but the focus is on upper arm or elbow surgery. An anesthesiology provider administers anesthesia to ensure the patient is safely sedated and pain-free during the procedure. The clinical workflow involves preoperative assessment, induction of anesthesia, intraoperative monitoring, and postoperative recovery. Providers involved may include an anesthesiologist, Certified Registered Nurse Anesthetist (CRNA), or Anesthesiology Assistant.

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 CRNA provides anesthesia services under the medical direction of a physician.

Associated Provider Taxonomies:

National Reimbursement Benchmarks

For CPT code 01742, the national mean rate for BUCA (average commercial) is $134.08, which is substantially higher than the UnitedHealth Group mean rate of $65.54. Among commercial payers, Cigna has the highest mean rate at $299.27, while UnitedHealth Group is the lowest.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Blue Cross Blue Shield shows the tightest range at $143.50, indicating more consistent rates, while Cigna exhibits the widest range at $344.00, reflecting greater variability in reimbursement. Aetna and BUCA also display considerable dispersion, with ranges of $272.00 and $155.78, respectively.

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 wide rate spread for CPT code 01742, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $96.73 ($371.33 minus $274.60). BUCA also shows a substantial spread of $155.33 ($297.00 minus $141.67), indicating significant variability in reimbursement rates across payers. In contrast, Aetna, Cigna, and UnitedHealth Group have much narrower spreads, with all percentiles clustered closely together.

Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are notably higher, while Cigna and UnitedHealth Group are below or near national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these differences and the range of reimbursement values across the state.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 01742 in Alaska, with a mean rate of $328.02.
UnitedHealth Group offers the lowest mean rate at $74.78.
Alaska's mean rates for most payers are significantly higher than national averages, especially for Blue Cross Blue Shield and BUCA.

Related Codes

01390

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

01440

CPT 01440: Anesthesia for Knee and Popliteal Artery Procedures

01212

CPT 01212: Anesthesia for Open Hip Joint Procedures, Hip Disarticulation

01232

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

01610

CPT 01610: Anesthesia for Knee Joint Procedures, Unspecified

01670

CPT 01670: Anesthesia for Procedures on the Shoulder and Axilla

01392

CPT 01392: Anesthesia for Knee Area Surgery

01760

CPT 01760: Anesthesia for Procedures on the Upper Arm and Elbow

01620

CPT 01620: Anesthesia for Knee and Popliteal Area Procedures

01638

CPT 01638: Anesthesia for Shoulder and Axilla Procedures

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