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.

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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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CPT 01250: Anesthesia for Upper Leg Soft-Tissue Procedures

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

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Sign up for cpt 01250 policy alerts

Get alerted when payer policies referencing 01250 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

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 Code	Description	Relationship to This Procedure
`29827`	Arthroscopy, shoulder, surgical; with rotator cuff repair	Common primary surgical procedure for which anesthesia `01250` would be provided; intraoperative analgesia and airway management required.
`23412`	Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic	Open rotator cuff repair option — anesthesia services for an open approach are billed similarly and may require broader regional or general anesthesia.
`20610`	Arthrocentesis, aspiration and/or injection into a major joint or bursa	May be performed preoperatively for diagnostic or therapeutic reasons or intraoperatively for joint management; anesthesia may be minimal or MAC.
`29826`	Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty	Frequently performed with rotator cuff procedures; anesthesia `01250` covers intraoperative care for this concurrent arthroscopic procedure.

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –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…
23	Modifier -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…
50	Modifier –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…
52	Modifier ‑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…
53	Modifier 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…
55	Modifier –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…
62	Modifier 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…
78	CPT 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	Specialty	Notes
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207LA0401X	Addiction Medicine (Anesthesiology) Physician	An anesthesiologist who specializes in the diagnosis and treatment of addictions.
367500000X	Certified Registered Nurse Anesthetist	(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, prov…
246YC3302X	Physician Office Based Coding Specialist	None
103TP2701X	Group Psychotherapy Psychologist	A psychologist who specializes in group psychology and group psychotherapy that is an evidenced-based specialty that prepares group leaders to identif…
207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	An ophthalmologist who specializes in the treatment of glaucoma and other disorders related to increased intraocular pressure and optic nerve damage. …
251C00000X	Developmentally Disabled Services Day Training Agency	These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of d…
2081P0010X	Pediatric Rehabilitation Medicine Physician	A physiatrist who utilizes an interdisciplinary approach and addresses the prevention, diagnosis, treatment and management of congenital and childhood…

Related ICD-10-CM Codes

29 rows

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

Showing 1–10 of 29

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.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.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.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 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.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29827`	Arthroscopy, shoulder, surgical; with rotator cuff repair	Common primary surgical procedure for which anesthesia `01250` would be provided; intraoperative analgesia and airway management required.
`23412`	Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic	Open rotator cuff repair option — anesthesia services for an open approach are billed similarly and may require broader regional or general anesthesia.
`20610`	Arthrocentesis, aspiration and/or injection into a major joint or bursa	May be performed preoperatively for diagnostic or therapeutic reasons or intraoperatively for joint management; anesthesia may be minimal or MAC.
`29826`	Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty	Frequently performed with rotator cuff procedures; anesthesia `01250` covers intraoperative care for this concurrent arthroscopic procedure.

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –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…
23	Modifier -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…
50	Modifier –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…
52	Modifier ‑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…
53	Modifier 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…
55	Modifier –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…
62	Modifier 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…
78	CPT 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	Specialty	Notes
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207LA0401X	Addiction Medicine (Anesthesiology) Physician	An anesthesiologist who specializes in the diagnosis and treatment of addictions.
367500000X	Certified Registered Nurse Anesthetist	(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, prov…
246YC3302X	Physician Office Based Coding Specialist	None
103TP2701X	Group Psychotherapy Psychologist	A psychologist who specializes in group psychology and group psychotherapy that is an evidenced-based specialty that prepares group leaders to identif…
207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	An ophthalmologist who specializes in the treatment of glaucoma and other disorders related to increased intraocular pressure and optic nerve damage. …
251C00000X	Developmentally Disabled Services Day Training Agency	These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of d…
2081P0010X	Pediatric Rehabilitation Medicine Physician	A physiatrist who utilizes an interdisciplinary approach and addresses the prevention, diagnosis, treatment and management of congenital and childhood…

Related ICD-10-CM Codes

29 rows

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

Showing 1–10 of 29

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.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.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.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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CPT 01250: Anesthesia for Upper Leg Soft-Tissue Procedures

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National Reimbursement Benchmarks

OpenPayer

CPT 01250: Anesthesia for Upper Leg Soft-Tissue Procedures

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National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

CPT 01250: Anesthesia for Upper Leg Soft-Tissue Procedures

Sign up for cpt 01250 policy alerts

National Reimbursement Benchmarks

CPT 01250: Anesthesia for Upper Leg Soft-Tissue Procedures

Sign up for cpt 01250 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What procedures is CPT 01250 intended to cover?

In what setting is CPT 01250 typically reported?

Which common surgical CPT codes are related to or performed with anesthesia services similar to CPT 01250?

What diagnoses are commonly associated with procedures that would require CPT 01250 anesthesia services?

Which payers are indicated as covered in the summary metadata for this code?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What procedures is CPT 01250 intended to cover?

In what setting is CPT 01250 typically reported?

Which common surgical CPT codes are related to or performed with anesthesia services similar to CPT 01250?

What diagnoses are commonly associated with procedures that would require CPT 01250 anesthesia services?

Which payers are indicated as covered in the summary metadata for this code?

References