Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesAnesthesia for Procedures on the Upper Leg (Except Knee)CPT cpt-01260-anesthesia-for-upper-leg-vein-procedure-exploration
    Ask Trek AI about this page

    CPT 01260: Anesthesia for Veins of Upper Leg, Including Exploration

    Commercial payers pay $83 on average nationally for this procedure.

    CPT code 01260 describes anesthesia services provided for procedures on the veins of the upper leg, including exploration; this represents anesthetic management for vascular-focused surgical intervention and is typically performed in an operating room or procedure suite as an intraoperative anesthesia service.

    For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.

    Customize your policy alerts

    Sign up for cpt 01260 policy alerts

    Get alerted when payer policies referencing 01260 are released or updated.

    Monitor payer policy activity

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

    National Reimbursement Benchmarks

    BUCA’s average commercial rate for CPT 01260 is $83.4, positioning it near the center of the national commercial distribution. Among named payers, Cigna’s mean of $96.1 sits above BUCA, while UnitedHealth Group’s mean of $68.2 and Aetna’s mean of $86.3 are close to BUCA. Blue Cross Blue Shield’s mean of $83.3 aligns almost exactly with BUCA. Max/min values vary by carrier but are not discussed for BUCA. Dispersion (P75 minus P25) highlights where prices are most concentrated: Blue Cross Blue Shield shows a tight interquartile spread of $44.5 ($105.4 − $59.5), UnitedHealth Group is the tightest at $28.0 ($81.0 − $52.0), and Aetna and Cigna are wider with spreads of $67.6 ($111.8 − $42.4) and $46.4 ($117.8 − $71.4), respectively. BUCA’s interquartile spread is $47.6 ($104.5 − $57.4), indicating moderate dispersion relative to peers.

    Table of contents

    Progress1 / 9

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old male presents with progressive pain and swelling localized to the medial thigh and upper leg after a fall and progressive venous insufficiency. Imaging demonstrates thrombosed varicosities and a ruptured superficial vein requiring surgical exploration and repair of the veins of the upper leg. The patient has a history of controlled hypertension and well-managed type 2 diabetes mellitus. The vascular surgeon plans open exploration and repair of the affected upper leg veins under general endotracheal anesthesia with peripheral nerve block supplementation for postoperative analgesia.

    Preoperative workflow includes anesthesia preoperative evaluation, consent for anesthesia risks, review of recent labs and anticoagulation status, medication reconciliation, and placement of standard ASA monitors in the operating room. Anesthesia services include induction of general anesthesia, airway management, maintenance of anesthesia, intraoperative hemodynamic management, and regional block placement as indicated. Postoperative handoff includes recovery room vigilance for bleeding, hemodynamic stability, pain control, and assessment of neurovascular status of the limb.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    01250Anesthesia for procedures on nerve, muscle, tendon, fascia and bursa of upper legUsed when the surgical procedure involves adjacent soft tissue structures rather than venous repair; may be selected if documented procedure targets these tissues.

    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…
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    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 CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207LA0401XAddiction Medicine (Anesthesiology) PhysicianAn anesthesiologist who specializes in the diagnosis and treatment of addictions.
    207LP2900XPain Medicine (Anesthesiology) PhysicianAn anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chr…
    163WM0705XMedical-Surgical Registered NurseNursing Service Providers · Registered Nurse
    2471C1106XCardiac-Interventional Technology Radiologic TechnologistA radiologic technologist who specializes in cardiac interventional and is appropriately educated and trained, consistent with nationally recognized s…
    225XE1200XErgonomics Occupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers · Occupational Therapist
    363LP1700XPerinatal Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    207LP3000XPediatric Anesthesiology PhysicianAn anesthesiologist who has had additional skill and experience in and is primarily concerned with the anesthesia, sedation, and pain management needs…

    Related ICD-10-CM Codes

    30 rows

    ICD-10-CM CodeDescription
    E11.51Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
    I65.29Occlusion and stenosis of unspecified carotid artery
    I72.3Aneurysm of iliac artery
    I74.3Embolism and thrombosis of arteries of the lower extremities
    I74.4Embolism and thrombosis of arteries of extremities, unspecified
    I80.10Phlebitis and thrombophlebitis of unspecified femoral vein
    I80.11Phlebitis and thrombophlebitis of right femoral vein
    I80.12Phlebitis and thrombophlebitis of left femoral vein
    I80.209Phlebitis and thrombophlebitis of unspecified deep vessels of unspecified lower extremity
    I80.9Phlebitis and thrombophlebitis of unspecified site

    Showing 1–10 of 30

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    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
    Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_BlocksCigna2026-05-15
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01

    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.
    Published by

    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.

    01270Anesthesia for procedures involving arteries of upper leg, including bypass graftRelated when arterial work is performed in conjunction with venous surgery (for example, combined vascular procedures) or when arterial exposure is required during exploration.