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    v1.0.30
    OpenPayerBilling CodesAnesthesia for Procedures on the Knee and Popliteal AreaCPT cpt-01404-anesthesia-for-knee-joint-surgery
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    CPT 01404: Anesthesia for Open or Arthroscopic Knee Procedure

    Commercial payers pay $69 on average nationally for this procedure.

    CPT code 01404 describes anesthesia services provided for a patient undergoing an open or arthroscopic procedure, including disarticulation, at the knee joint; the service is an anesthesia service typically delivered in an operating room or ambulatory surgical center for knee surgical procedures.

    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 rates for CPT 01404 center around BUCA’s average commercial rate of $69.30, with meaningful variation across carriers. Cigna and Blue Cross Blue Shield exhibit higher central tendencies (Cigna median $86 and BCBS median $55.7) while Aetna and UnitedHealth Group sit lower (Aetna median $48, UnitedHealth Group median $63.8). This positions BUCA near the middle of the market, reflecting an average commercial benchmark rather than an extreme.

    Dispersion measured by the interquartile range (P75 − P25) highlights differences in rate stability: Cigna shows the widest IQR at $58.6 ($125 − $68.4), indicating substantial variability, followed by BUCA with an IQR of $37.3 ($87.4 − $49.1). Blue Cross Blue Shield and Aetna have moderate spreads of $36.6 ($80.5 − $44) and $36.9 ($77.09 − $42), respectively, while UnitedHealth Group is the tightest with an IQR of $28.9 ($80.9 − $52).

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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 patient with end-stage osteoarthritis of the right knee (M17.11) presents for total knee arthroplasty. The patient reports progressive pain, reduced range of motion, and functional limitation despite conservative care. Preoperative evaluation by the orthopaedic surgery team documents failed nonoperative measures and indicates planned open arthroplasty of the knee. The anesthesia team (Anesthesiology Physician 207L00000X or Certified Registered Nurse Anesthetist 367500000X) conducts a pre-anesthesia assessment, documents airway and medical comorbidities, and obtains informed consent for general anesthesia with regional nerve block as indicated.

    On the day of surgery the typical workflow includes preoperative regional block placement in a holding area or block room (if used), intraoperative monitoring and anesthesia management in the operating room during the open or arthroscopic knee procedure, emergence in the OR or PACU, and postoperative handoff to PACU nursing. Billing uses 01404 to report anesthesia for procedures at the knee joint. Perioperative documentation includes anesthesia start and stop times, ASA physical status (for example P3), any unusual services or complications, and medical necessity tied to diagnosis codes such as M17.11. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for authorization and claims submission workflows.

    Related CPT Codes

    CPT Code

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    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…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    367500000X
    207X00000X
    284300000X
    2081P2900X
    207QG0300X
    173000000X
    2086S0105X

    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-01320-ANESTHESIA-FOR-KNEE-POPLITEAL-SOFT-TISSUE-PROCEDURES

    CPT 01320: Anesthesia for Procedures on Knee and Popliteal Area

    CPT-01340-ANESTHESIA-CLOSED-PROCEDURE-LOWER-THIRD-FEMUR

    CPT 01340: Anesthesia for Closed Procedure of Lower One-Third of Femur

    CPT-01360-ANESTHESIA-OPEN-PROCEDURE-LOWER-FEMUR

    CPT 01360: Anesthesia for Open Procedure on Lower Femur

    CPT-01380-ANESTHESIA-CLOSED-KNEE-PROCEDURE

    CPT 01380: Anesthesia for Closed Procedure of Knee Joint

    CPT-01382-ANESTHESIA-DIAGNOSTIC-ARTHROSCOPY-KNEE

    CPT 01382: Anesthesia for Diagnostic Arthroscopic Procedure of Knee

    CPT-01390-ANESTHESIA-CLOSED-PROCEDURE-TIBIA-FIBULA-PATELLA

    CPT 01390: Anesthesia for Closed Procedure of Upper Tibia/Fibula/Patella

    CPT-01392-ANESTHESIA-OPEN-PROCEDURE-UPPER-TIBIA-FIBULA-PATELLA

    CPT 01392: Anesthesia for Open Upper Tibia/Fibula/Patella Procedure

    CPT-01400-ANESTHESIA-FOR-KNEE-SURGERY-OPEN-OR-ARTHROSCOPIC

    CPT 01400: Anesthesia for Open or Arthroscopic Knee Procedure

    CPT-01402-ANESTHESIA-TOTAL-KNEE-ARTHROPLASTY

    CPT 01402: Anesthesia for Total Knee Arthroplasty

    CPT-01420-ANESTHESIA-FOR-KNEE-INCLUDING-CAST-APPLICATION-REMOVAL-REPAIR

    CPT 01420: Anesthesia for Application/Removal/Repair of Knee-Including Cast

    Showing 1–10 of 15

    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 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.

    Description
    Relationship to This Procedure
    27447Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)Primary orthopaedic procedure often requiring anesthesia services reported with 01404 when anesthesia is provided for a knee arthroplasty.
    20610Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., knee)May be used preoperatively or diagnostically in the care pathway; anesthesia services for aspiration/injection typically billed separately if anesthesia is required.
    29881Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)Minimally invasive knee procedure that may be performed arthroscopically; anesthesia code 01404 covers anesthesia for arthroscopic knee procedures when applicable.
    29888Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstructionLigament reconstruction that may occur in the same operative setting; anesthesia services for these procedures are reported with 01404 when the site is the knee.