CPT 01202: Anesthesia for Arthroscopic Hip Procedure
CPT code 01202 denotes anesthesia services provided for arthroscopic procedures of the hip joint. As a procedure-specific anesthesia code, it facilitates billing for intraoperative anesthetic management during minimally invasive hip surgeries. Accurate use of this code is important for claims processing, provider reimbursement, and national tracking of anesthesia utilization for orthopedic arthroscopy.
Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication reviews payer coverage patterns, common claim-level modifiers, and clinical context surrounding arthroscopic hip procedures to support correct coding and coding consistency across payers.
Readers will find a concise overview of clinical indications for arthroscopic hip surgery, typical sites of service (hospital operating room and ambulatory surgery center), and related procedural context. The document also presents expected payer-specific considerations, common modifiers used with anesthesia services, and links to related orthopedic and anesthesia procedure codes for clinical correlation. This national-focused summary aims to clarify the code's clinical scope and billing context without state-specific policy detail. Data not available in the input is noted where applicable.
Sign up for cpt 01202 policy alerts
Get alerted when payer policies referencing 01202 are released or updated.
Billing Code Overview
CPT code 01202 describes anesthesia services furnished for a patient undergoing an arthroscopic procedure of the hip joint. This code represents the anesthesia component of care provided during minimally invasive, camera-assisted hip joint surgery.
-
Service type: Anesthesia for arthroscopic hip procedure
-
Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 55-year-old male presents with progressive right shoulder pain and weakness after a fall. Imaging demonstrates a suspected rotator cuff tear and subacromial impingement. The orthopedic surgeon schedules an arthroscopic shoulder procedure to evaluate and repair the rotator cuff and perform subacromial decompression if indicated. The anesthesia team provides general endotracheal anesthesia with an interscalene nerve block for perioperative analgesia. Preoperative evaluation documents ASA classification P2, relevant comorbidities, airway assessment, and informed consent for anesthesia. Intraoperative monitoring includes ECG, blood pressure, pulse oximetry, end-tidal CO2, and temperature. The anesthesiologist documents anesthetic start and stop times, regional block performance, any intraoperative complications (for example hypotension or unexpected severe bleeding), and post-anesthesia condition for handoff to PACU. Typical postoperative workflow includes PACU monitoring, opioid-sparing analgesia facilitated by the regional block, and discharge planning with activity and pain control instructions provided by the surgical team.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when anesthesia services require substantially greater work due to complexity, documented and justified in the anesthesiology record. |
23 | Unusual anesthesia | Use when general anesthesia is administered for a procedure that is normally performed with local/regional anesthesia due to unusual circumstances. |
50 | Bilateral procedure | Use if bilateral shoulder arthroscopic procedures are performed during the same anesthetic. |
52 | Reduced services | Use when the anesthetic service is partially reduced or discontinued and documentation supports decreased service. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances and anesthesia is discontinued accordingly. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons and anesthesia documentation supports shared operative responsibility impacting the anesthetic. |
78 | Unplanned return to the OR following initial procedure | Use when patient returns to the operating room during the global period and additional anesthesia is provided for related care. |
AA | Anesthesia by anesthesiologist | Use to indicate the service was personally performed by an anesthesiologist. |
AD | Medical supervision by anesthesiologist, more than four concurrent anesthetics | Use when the anesthesiologist supervises more than four concurrent cases and charges apply accordingly. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for anesthesia | Use when a qualified non-physician anesthesia provider performs the service under appropriate supervision. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use when the physician medically directs multiple concurrent anesthesia procedures and requirements are met. |
QS | Monitored anesthesia care (MAC) service | Use when MAC is provided instead of general anesthesia and the service is billed appropriately. |
QX | Anesthesia service furnished with qualified non-physician anesthetist (with QZ) | Use when a CRNA furnishes the service with medical direction documented (paired with QY/QZ as appropriate). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Board-certified anesthesiologists commonly provide general and regional anesthesia for shoulder arthroscopy. |
207LA0401X | Pain Medicine Anesthesiologist | Specialists in regional and perioperative pain management; may perform ultrasound-guided nerve blocks. |
207LP2900X | Pediatric Anesthesiology | Relevant when pediatric patients undergo shoulder arthroscopy; pediatric subspecialist provides age-specific anesthesia care. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M75.100 | Unspecified rotator cuff tear or rupture of shoulder | Primary indication for shoulder arthroscopy to evaluate and repair rotator cuff pathology. |
S43.401A | Sprain of unspecified acromioclavicular joint, initial encounter | Acute AC joint sprain can present with pain and instability leading to arthroscopic evaluation or concomitant procedures. |
M19.011 | Primary osteoarthritis, right shoulder | Degenerative changes may necessitate arthroscopic debridement or influence surgical planning. |
M25.511 | Pain in right shoulder | Symptom code supporting medical necessity for diagnostic or therapeutic arthroscopy. |
S42.001A | Fracture of unspecified part of right clavicle, initial encounter | Acute clavicle fractures may require surgical intervention or influence perioperative planning for shoulder arthroscopy. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
29826 | Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament release, when performed | Commonly performed arthroscopic adjunct to rotator cuff repair to relieve impingement during the same surgical session. |
23412 | Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic | Open rotator cuff repair may be an alternative to arthroscopic repair or required if conversion from arthroscopy is necessary. |
20610 | Arthrocentesis, aspiration and/or injection, major joint or bursa | May be used preoperatively for diagnostic aspiration or intraoperative/injection procedures for pain control. |
29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair | Directly related when an arthroscopic rotator cuff repair is performed instead of or in addition to decompression. |