CPT 01474: Anesthesia for Lower Leg, Ankle, and Foot Soft-Tissue Procedures
CPT code 01474 designates anesthesia services for procedures on the nerves, muscles, tendons, and fascia of the lower leg, ankle, and foot, and explicitly includes gastrocnemius recession (eg, Strayer procedure). This code matters nationally because anesthesia coding directly affects perioperative payment, resource allocation, and clinical workflow for lower-extremity soft-tissue and tendon surgeries performed in ambulatory surgery centers and hospital operating rooms.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of clinical context for the code, typical sites of service, and how this code relates to neighboring anesthesia codes for lower-extremity procedures. The publication summarizes common payer coverage patterns and billing considerations relevant to anesthesia professionals and billing teams, highlights associated service definitions, and identifies related anesthesia codes used for adjacent procedure groups.
This summary equips clinicians, anesthetists, and billing professionals with a clear understanding of what CPT code 01474 represents, the settings in which it is commonly billed, and the payer landscape addressed in the report. Data not available in the input will be noted where applicable in detailed sections.
Sign up for cpt 01474 policy alerts
Get alerted when payer policies referencing 01474 are released or updated.
Billing Code Overview
CPT code 01474 describes anesthesia services provided for surgical procedures on the nerves, muscles, tendons, and fascia of the lower leg, ankle, and foot, and specifically includes procedures such as a gastrocnemius recession (eg, Strayer procedure). The service type is anesthesia for lower leg/ankle/foot soft-tissue procedures. The typical site of service is an operating room or ambulatory surgical center where lower extremity soft-tissue and tendon procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 62-year-old ambulatory patient with chronic right-sided posterior ankle and Achilles region pain and tightness presents for surgical release of the gastrocnemius aponeurosis (gastrocnemius recession, e.g., Strayer procedure) to improve ankle dorsiflexion and relieve tension on the Achilles tendon. Preoperative evaluation documents history of unilateral knee osteoarthritis with prior right total knee arthroplasty (Z96.651), controlled hypertension, and ASA physical status P3. The surgical plan includes open gastrocnemius recession with possible adjunctive release of adhesions in the posterior compartment of the lower leg and local nerve decompression if identified.
The anesthesia workflow typically includes preoperative assessment by an anesthesiologist or certified registered nurse anesthetist (CRNA), establishment of standard ASA monitors, and placement of either general anesthesia with endotracheal tube or laryngeal mask airway or monitored regional anesthesia (e.g., popliteal sciatic nerve block) depending on patient preference, comorbidities, and surgeon requirements. Intraoperative management addresses positioning for lower leg/ankle access, perioperative antibiotics, and multimodal analgesia. Postoperative care includes PACU monitoring, assessment for block effectiveness and motor function, and discharge planning to same-day outpatient surgery or short inpatient stay based on anesthesia type and medical complexity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than usual for 01474 due to complexity or prolonged anesthesia management. |
23 | Unusual anesthesia due to emergency circumstances | Use if anesthesia is provided under emergency conditions for this procedure. |
50 | Bilateral procedure | Use when identical procedures are performed on both lower extremities during the same session. |
52 | Reduced services | Use when the anesthesia service is partially reduced or not completed as originally planned. |
53 | Discontinued procedure | Use if the procedure was started but terminated for patient-related or operative reasons prior to completion. |
55 | Postoperative management only | Use when the anesthesiologist provides only postoperative pain management and not intraoperative care for 01474. |
62 | Two surgeons | Use when two surgeons contribute distinct primary surgical services affecting anesthesia planning and billing. |
78 | Unplanned return to OR following initial procedure | Use for anesthesia related to an unplanned return to the operating room for a complication of the original procedure. |
AA | Anesthesia services performed personally by anesthesiologist | Use when the anesthesiologist personally performs the anesthesia for this service. |
AD | Medical supervision by anesthesiologist; more than four concurrent anesthesia cases | Use when the anesthesiologist provides direct supervision beyond usual staffing models for 01474. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist service as anesthesiologist | Use when an authorized non-physician functions in the role of the anesthesiologist under appropriate supervision for this service. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use when the anesthesiologist medically directs multiple concurrent 01474 services. |
QS | Monitored anesthesia care (MAC) service | Use when MAC is provided rather than general anesthesia or a regional block alone. |
59 | Distinct procedural service | Use when a separate, distinct anesthesia service is documented for an additional unrelated procedure during the same operative session. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Board-certified anesthesiologists who provide perioperative anesthesia care for lower leg, ankle, and foot procedures. |
207LA0401X | Pain Medicine (Anesthesiology) | Anesthesiologists with pain fellowship training who may provide regional blocks or advanced pain management adjuncts. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs who deliver anesthesia services in both inpatient and ambulatory surgical settings for 01474. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M17.10 | Unilateral primary osteoarthritis, unspecified knee | Osteoarthritis can alter gait mechanics and contribute to posterior leg tension; relevant comorbidity impacting perioperative care for lower leg procedures. |
M17.11 | Unilateral primary osteoarthritis, right knee | Side-specific osteoarthritis affecting biomechanics and rehabilitation expectations after Achilles/gastrocnemius procedures. |
M17.12 | Unilateral primary osteoarthritis, left knee | Side-specific osteoarthritis affecting biomechanics and rehabilitation expectations after gastrocnemius recession. |
M17.5 | Other unilateral secondary osteoarthritis of knee | Secondary joint disease from prior injury or alignment issues can influence surgical indications and postoperative mobility. |
Z96.651 | Presence of right artificial knee joint | Prior right knee arthroplasty affects positioning, thrombosis risk assessment, and perioperative antibiotic/implant considerations. |
Z96.652 | Presence of left artificial knee joint | Prior left knee arthroplasty affects positioning, thrombosis risk assessment, and perioperative antibiotic/implant considerations. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01472 | Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot (including repair of ruptured Achilles tendon, with or without graft) | Alternative anesthesia code for similar soft-tissue procedures of the lower leg/ankle; used when procedure specifics align more closely with tendon repair than gastrocnemius recession. |
01480 | Anesthesia for open procedures on bones of the lower leg, ankle, and foot | Used when an open bony procedure (e.g., osteotomy, fusion) is performed in conjunction with or instead of soft-tissue gastrocnemius recession; different anesthetic planning and complexity may apply. |