CPT 01969: Anesthesia for Cesarean Delivery After Neuraxial Labor Analgesia - OpenPayer

Beta

OpenPayer Beta

Summary & Overview

CPT 01969: Anesthesia for Cesarean Delivery After Neuraxial Labor Analgesia

CPT code 01969 represents anesthesia for cesarean delivery following neuraxial labor analgesia or anesthesia, a critical service in obstetric care. This code is widely used in inpatient hospital settings to ensure proper documentation and reimbursement for anesthesia professionals involved in cesarean sections after labor analgesia. The publication covers major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer coverage and policy considerations.

Readers will gain insight into the clinical context of 01969, including its role in supporting safe and effective anesthesia during cesarean deliveries. The summary includes benchmarks for utilization, policy updates relevant to anesthesiology billing, and an overview of associated clinical scenarios. Key modifiers and taxonomies are discussed to clarify billing practices and provider qualifications. Additionally, the publication highlights related CPT codes and common ICD-10 diagnoses encountered in cesarean delivery cases, offering a well-rounded perspective for healthcare professionals, administrators, and policy analysts. This resource is designed to inform stakeholders about the national landscape for anesthesia billing in obstetric care, focusing on accurate coding and payer requirements.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01969anesthesiologycesarean deliveryinpatient hospitalobstetric anesthesiamedical billingclinical codingpolicy updatebenchmarksmodifier codes

CPT Code Overview

CPT code 01969 is used to report anesthesia services for cesarean delivery following neuraxial labor analgesia or anesthesia. This code applies to situations where a patient initially receives neuraxial anesthesia for labor and subsequently requires a cesarean section, necessitating continued or adjusted anesthesia care. The service type is anesthesiology, and the typical site of service is an inpatient hospital (Place of Service 21). This code is essential for accurately documenting and billing anesthesia care during cesarean deliveries that follow neuraxial labor analgesia.

Clinical & Coding Specifications

Clinical Context

A patient is admitted to an inpatient hospital for labor and delivery. During labor, neuraxial analgesia/anesthesia is administered to manage pain. Due to clinical indications such as maternal exhaustion, failed trial of labor after previous cesarean delivery, or inadequate contractions, the decision is made to proceed with a cesarean delivery. Anesthesia for the cesarean section is provided following the initial neuraxial labor analgesia/anesthesia. The procedure is performed by an anesthesiologist or a certified registered nurse anesthetist, often in collaboration with an obstetrician.

Coding Specifications

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.
Modifier QX is used when a certified registered nurse anesthetist (CRNA) provides the service with medical direction by a physician.

National Reimbursement Benchmarks

National mean rates for CPT code 01969 show that Blue Cross Blue Shield and Cigna have the highest average reimbursement, both exceeding $299, while UnitedHealth Group is notably lower at $65.55. The BUCA (average commercial) mean rate stands at $144.56, which is significantly higher than UnitedHealth Group but well below Blue Cross Blue Shield and Cigna. Medicare rates are not available in the input for comparison.

Rate dispersion varies considerably across payers. UnitedHealth Group has the tightest range between the 25th and 75th percentiles ($24.75), indicating less variability in contracted rates. In contrast, Cigna and Blue Cross Blue Shield exhibit the widest dispersions ($344.50 and $238.35, respectively), reflecting greater variability in their national payment rates. The table and chart below present the full breakdown of national benchmarks for each payer.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska displays a wide range in reimbursement rates for CPT code 01969, with Blue Cross Blue Shield offering the highest mean rate at $328.09 and UnitedHealth Group the lowest at $74.78. 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 ($156.37), indicating significant variability in payments across providers. In contrast, Aetna and UnitedHealth Group show minimal spread, with all percentiles clustered closely around $72.00–$75.00.

Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are substantially higher, while Cigna and UnitedHealth Group remain below their national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting the state's unique reimbursement landscape for this procedure.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 01969, with a mean rate of $328.09.
UnitedHealth Group offers the lowest mean rate at $74.78, significantly below both the state and national averages.
Alaska's mean rates for most payers, especially Blue Cross Blue Shield and BUCA, are notably higher than their respective national averages, indicating a premium reimbursement environment.

Related Codes

01952

CPT 01952: Anesthesia for Burn Excision/Debridement, 4–9% TBSA

01967

CPT 01967: Anesthesia for Planned Vaginal Delivery

01990

CPT 01990: Anesthesia for Physiological Support During Organ Procurement

01922

CPT 01922: Anesthesia for Non-Invasive Imaging or Radiation Therapy Procedures

01935

CPT 01935: Anesthesia for Percutaneous Image-Guided Spine Diagnostic Procedures

01931

CPT 01931: Anesthesia for Eye Lens Surgery

01920

CPT 01920: Anesthesia for Cardiac Catheterization and Coronary Angiography

01926

CPT 01926: Anesthesia for Therapeutic Interventional Radiological Procedures

01953

CPT 01953: Anesthesia for Burn Excision or Debridement, Additional 9% TBSA

01966

CPT 01966: Anesthesia for Induced Abortion Procedures

Showing 1–10 of 27

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.