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    OpenPayerBilling CodesAnesthesia for Procedures on the Upper Leg (Except Knee)CPT cpt-01234-anesthesia-radical-resection-upper-femur
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    CPT 01234: Anesthesia for Radical Resection of Upper Two-Thirds of Femur

    Commercial payers pay $68 on average nationally for this procedure.

    CPT code 01234 describes anesthesia services provided for a patient undergoing a radical resection or extensive surgical removal of tissue of the upper two thirds of the femur (thigh bone); service type: anesthesia for major lower extremity bone resection; typical site of service: inpatient or ambulatory surgical center for orthopedic surgery involving the proximal femur.

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

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    National Reimbursement Benchmarks

    National commercial reimbursements for CPT 01234 cluster around BUCA’s average commercial rate of $68, while individual payers show meaningful variation. Blue Cross Blue Shield has a mean of $62.2 and a median of $52.8, Aetna’s mean is $60.3 with a median of $48, Cigna’s mean is notably higher at $93.7 with a median of $85.7, and UnitedHealth Group’s mean is $67.2 with a median of $63.7. Cigna and Aetna define the upper and lower ends of the typical range among these payers, with Cigna’s higher central tendency pulling the commercial average upward relative to some peers.

    Dispersion (P75 minus P25) highlights where rates are tightest and widest: Blue Cross Blue Shield and Aetna both have a dispersion of $30.0 ($76.4 - $42.4 for BCBS; $76.4 - $42.0 for Aetna) indicating similar variability. UnitedHealth Group’s dispersion is $27.0 ($80.8 - $51.4), the tightest of the four payers. Cigna shows the widest dispersion at $53.1 ($119.9 - $67.9), reflecting broader negotiated outcomes around its higher central rates.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old ambulatory patient with progressive right hip and proximal femoral pain from advanced osteoarthritis is scheduled for a radical resection of the upper two-thirds of the right femur (radical femoral resection) for severe degenerative disease with failed conservative care. Preoperative evaluation is performed by the anesthesia team including an anesthesiologist and a certified registered nurse anesthetist. The patient has comorbid hypertension and controlled type 2 diabetes and an American Society of Anesthesiologists physical status of P3.

    On the day of surgery the patient arrives to an orthopedic operating room at an inpatient hospital. Standard monitoring is applied, including arterial line access for hemodynamic monitoring given anticipated blood loss. General endotracheal anesthesia is induced for surgical exposure and oncologic-style or extensive resection of the proximal femur, with planned intraoperative transfusion if needed. The anesthesia team documents start and stop times for anesthesia services, communicates with the orthopaedic surgeons regarding intraoperative positioning and blood loss, and coordinates postoperative analgesia and transfer to the post-anesthesia care unit (PACU) and then to an inpatient orthopedic ward for recovery and rehabilitation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    01232Anesthesia for open procedures involving upper two‑thirds of femur; amputation

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    367500000X
    207X00000X
    2865C1500X
    207RC0200X
    363L00000X
    2278P4000X
    332U00000X

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

    CPT-01200-ANESTHESIA-CLOSED-HIP-PROCEDURE

    CPT 01200: Anesthesia for Closed Procedure on Hip Joint

    CPT-01202-ARTHROSCOPIC-HIP-ANESTHESIA

    CPT 01202: Anesthesia for Hip Arthroscopy

    CPT-01210-ANESTHESIA-OPEN-PROCEDURE-HIP-JOINT

    CPT 01210: Anesthesia for Open Procedure of Hip Joint

    CPT-01212-HIP-DISARTICULATION-ANESTHESIA

    CPT 01212: Anesthesia for Open Disarticulation of Hip

    CPT-01214-ANESTHESIA-OPEN-TOTAL-HIP-ARTHROPLASTY

    CPT 01214: Anesthesia for Open Total Hip Arthroplasty

    CPT-01215-ANESTHESIA-REVISION-TOTAL-HIP-ARTHROPLASTY

    CPT 01215: Anesthesia for Revision of Open Total Hip Arthroplasty

    CPT-01220-ANESTHESIA-CLOSED-PROCEDURE-UPPER-FEMUR

    CPT 01220: Anesthesia for Closed Procedure of Upper Two-Thirds of Femur

    CPT-01230-ANESTHESIA-OPEN-UPPER-TWO-THIRDS-FEMUR

    CPT 01230: Anesthesia for Open Procedure of Upper Two-Thirds of Femur

    CPT-01232-ANESTHESIA-AMPUTATION-UPPER-THIGH-FEMUR

    CPT 01232: Anesthesia for Amputation of Upper Femur

    CPT-01250-ANESTHESIA-UPPER-LEG-SOFT-TISSUE-PROCEDURES

    CPT 01250: Anesthesia for Upper Leg Soft-Tissue Procedures

    Showing 1–10 of 14

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.

    Closely related anesthesia code for open proximal femoral procedures or amputation; may be used for similar anatomic level or variant surgical approaches.