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    v1.0.30
    OpenPayerBilling CodesAnesthesia for Procedures on the Upper Leg (Except Knee)CPT cpt-01250-anesthesia-upper-leg-soft-tissue-procedures
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    CPT 01250: Anesthesia for Upper Leg Soft-Tissue Procedures

    Commercial payers pay $90 on average nationally for this procedure.

    CPT code 01250 describes anesthesia services provided for procedures on the nerves, muscles, tendons, fascia, and bursae of the upper leg; this represents regional or general anesthesia care delivered in an operating room or procedure suite for soft-tissue or nerve-related surgical interventions of the proximal lower extremity.

    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

    Commercial reimbursements for CPT 01250 cluster around BUCA’s average commercial rate of $90.40, with individual payers displaying meaningful differences in central tendency and upper-end caps. Blue Cross Blue Shield’s median sits near $67.20 while Cigna and Aetna have higher medians at $84.40 and $122.70 respectively; UnitedHealth Group’s median is $64.00. Aetna shows the highest top-of-market at $497.00, while UnitedHealth Group and Blue Cross Blue Shield cap near $122.70 and $208.10 respectively, indicating distinct ceiling effects across carriers.

    Rate dispersion measured by the interquartile range (P75 − P25) highlights variation in pricing consistency: Aetna’s IQR is $130.30 (from $57.00 to $205.00), the widest spread, followed by Cigna at $41.40 (from $67.60 to $108.20). Blue Cross Blue Shield’s IQR is $50.30 and UnitedHealth Group’s is $30.90, making UnitedHealth the tightest among these payers. BUCA’s IQR is $58.20, placing it between UnitedHealth Group and Blue Cross Blue Shield in terms of dispersion.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 56-year-old patient presents for operative management of a right rotator cuff tear with persistent pain and dysfunction after conservative care. The orthopedic surgeon schedules arthroscopic rotator cuff repair with subacromial decompression under general anesthesia with regional block support. Preoperative evaluation by the anesthesia team documents ASA classification P3 for controlled hypertension and type 2 diabetes. On the day of surgery the patient arrives to the ambulatory surgery center; standard monitors are applied, informed consent for anesthesia is obtained, and an interscalene brachial plexus nerve block is performed for perioperative analgesia. General endotracheal anesthesia is induced, and intraoperative anesthesia care is rendered throughout the shoulder procedure including management of hemodynamics, airway, and postoperative handoff to PACU. The expected site of service is an outpatient ambulatory surgery center or hospital operating room for procedures on the shoulder girdle (nerves, muscles, tendons, fascia, and bursae of the upper limb). Typical clinical workflow includes preoperative assessment, regional block placement (when indicated), intraoperative anesthetic management, and postoperative recovery with pain control and discharge or inpatient admission as required.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    29827Arthroscopy, shoulder, surgical; with rotator cuff repair

    Related Modifiers

    8 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…
    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
    207LA0401X
    367500000X
    246YC3302X
    103TP2701X
    207WX0009X
    251C00000X
    2081P0010X

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    G56.01Carpal tunnel syndrome, right upper limb
    G56.02Carpal tunnel syndrome, left upper limb
    M19.011Primary osteoarthritis, right shoulder
    M19.012Primary osteoarthritis, left shoulder
    M24.219Disorder of ligament, unspecified shoulder
    M24.271Disorder of ligament, right ankle
    M25.561Pain in right knee
    M25.562Pain in left knee
    M25.661Stiffness of right knee, not elsewhere classified
    M62.81Muscle weakness (generalized)

    Showing 1–10 of 29

    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-01234-ANESTHESIA-RADICAL-RESECTION-UPPER-FEMUR

    CPT 01234: Anesthesia for Radical Resection of Upper Two-Thirds of Femur

    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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    Common primary surgical procedure for which anesthesia 01250 would be provided; intraoperative analgesia and airway management required.
    23412Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronicOpen rotator cuff repair option — anesthesia services for an open approach are billed similarly and may require broader regional or general anesthesia.
    20610Arthrocentesis, aspiration and/or injection into a major joint or bursaMay be performed preoperatively for diagnostic or therapeutic reasons or intraoperatively for joint management; anesthesia may be minimal or MAC.
    29826Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplastyFrequently performed with rotator cuff procedures; anesthesia 01250 covers intraoperative care for this concurrent arthroscopic procedure.