CPT 01967 (CPT) Reimbursement Benchmarks | OpenPayer

Summary & Overview

CPT 01967: Anesthesia for Planned Vaginal Delivery

CPT code 01967 represents anesthesia services provided for planned vaginal delivery, a critical component of obstetric care in hospital settings across the United States. This code is widely used by anesthesiologists and certified registered nurse anesthetists to document and bill for their involvement in labor and delivery procedures. The code is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage and reimbursement for these essential services.

This publication offers a comprehensive overview of 01967, including its clinical context, typical site of service, and relevance in obstetric anesthesia. Readers will gain insights into payer coverage, common billing practices, and associated clinical scenarios. The analysis also highlights related codes and modifiers, providing clarity on how 01967 fits within the broader landscape of obstetric anesthesia billing. Key benchmarks and policy updates are discussed to inform stakeholders about current trends and requirements. The information presented is designed to support healthcare professionals, administrators, and policy analysts in understanding the national significance of this CPT code and its role in maternal care.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01967obstetric anesthesiaanesthesiologyhospital inpatientlabor and deliverymedical billingplanned vaginal deliveryclinical codingpolicy updatebenchmarking

CPT Code Overview

CPT code 01967 is used to report anesthesia services for planned vaginal delivery procedures. This code falls under the anesthesiology service type, specifically for obstetric anesthesia. The typical site of service for this procedure is the hospital inpatient setting, such as a labor and delivery unit (Place of Service 21). This code is essential for accurately documenting and billing anesthesia care provided during labor and delivery.

Clinical & Coding Specifications

Clinical Context

A patient is admitted to the hospital's Labor and Delivery unit for a planned vaginal delivery. During labor, the patient requires anesthesia services to manage pain and facilitate the delivery process. An anesthesiologist or a Certified Registered Nurse Anesthetist (CRNA), possibly under the medical direction of a physician, provides obstetric anesthesia. The procedure is coded as 01967, which covers anesthesia for planned vaginal delivery. The clinical workflow involves pre-anesthesia assessment, administration of neuraxial anesthesia (such as epidural or spinal), monitoring throughout labor, and post-delivery care.

Coding Specifications

Common Modifiers:

Modifier Code	Description
`AA`	Anesthesia services performed personally by anesthesiologist
`QX`	CRNA service with medical direction by a physician

Modifier AA is used when the anesthesiologist personally performs the anesthesia service.

National Reimbursement Benchmarks

National mean rates for CPT code 01967 show that Blue Cross Blue Shield and Cigna have the highest average reimbursement, with $494.55 and $467.68 respectively. UnitedHealth Group is notably lower at $65.57. The BUCA average commercial rate stands at $272.89, which is substantially higher than UnitedHealth Group but lower than the other major commercial payers. Medicare data is not available in the input.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. UnitedHealth Group has the tightest range at $24.75, indicating less variability in rates. Blue Cross Blue Shield exhibits the widest range at $446.80, followed by Aetna and Cigna, both with ranges over $500. This suggests that some payers have more consistent reimbursement levels, while others show greater variability.

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

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska displays a significant spread in reimbursement rates for CPT code 01967 across commercial payers. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($96.90) and BUCA ($183.50), indicating substantial variability in payments. In contrast, Aetna, Cigna, and UnitedHealth Group show much narrower spreads, with Cigna and UnitedHealth Group both having only $8.00 between their 25th and 75th percentiles.

Compared to national averages, mean rates for Aetna, Blue Cross Blue Shield, and BUCA in Alaska are considerably higher, while Cigna and UnitedHealth Group are below their national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting these differences and the overall landscape for CPT code 01967 reimbursement.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 01967 in Alaska, with a mean rate of $328.44.
UnitedHealth Group is the lowest paying payer, with a mean rate of $74.78.
Mean rates for Aetna, Blue Cross Blue Shield, and BUCA in Alaska are notably higher than their respective national averages, while Cigna and UnitedHealth Group are below national benchmarks.

CPT 01962: Anesthesia for Urgent Post-Delivery Hysterectomy

01958-ANESTHESIA-FOR-EXTERNAL-CEPHALIC

CPT 01958: Anesthesia for External Cephalic Version

01960-UNDER-ANESTHESIA-FOR-OBSTETRIC-PROCEDURES-VAGINAL

CPT 01960: Anesthesia for Vaginal Delivery

01965-ANESTHESIA-FOR-CESAREAN-DELIVERY

CPT 01965: Anesthesia for Cesarean Delivery Only

01968-ANESTHESIA-FOR-CESAREAN-DELIVERY-FOLLOWING-NEURAXIAL-LABOR

CPT 01968: Anesthesia for Cesarean Delivery After Neuraxial Labor Analgesia

01969-ANESTHESIA-FOR-CESAREAN-DELIVERY-FOLLOWING-NEURAXIAL-LABOR

CPT 01969: Anesthesia for Cesarean Delivery After Neuraxial Labor Analgesia

01966-ANESTHESIA-FOR-INDUCED-ABORTION

CPT 01966: Anesthesia for Induced Abortion Procedures

01961-ANESTHESIA-FOR-CESAREAN-DELIVERY

CPT 01961: Anesthesia for Cesarean Delivery Only

01963-UNDER-ANESTHESIA-FOR-OBSTETRIC-PROCEDURES-CESAREAN

CPT 01963: Anesthesia for Cesarean Hysterectomy Without Labor Analgesia

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.

Taxonomy Code	Specialty
`207L00000X`	Anesthesiology
`367500000X`	Certified Registered Nurse Anesthetist
`207V00000X`	Obstetrics & Gynecology Physician

Related CPT Codes

CPT Code	Description
`01968`	Under anesthesia for obstetric procedures (cesarean delivery following neuraxial anesthetic)

01968 is used when a cesarean delivery is performed following neuraxial anesthesia that was initiated for planned vaginal delivery (coded as 01967).
01967 and 01968 are commonly used together in cases where labor begins as a planned vaginal delivery but transitions to a cesarean section requiring continued anesthesia.