CPT 01490: Anesthesia for Lower Leg Cast Application, Removal, or Repair
CPT code 01490 denotes anesthesia services for the application, removal, or repair of a lower leg cast. This code captures peri-procedural anesthesia specifically associated with lower leg casting procedures and is relevant for clinicians, anesthesiology groups, and payers managing perioperative billing for minor lower-extremity interventions. Nationally, accurate use of this CPT code supports appropriate payment for anesthesia time and complexity linked to immobilization procedures and helps differentiate anesthesia services from procedure-only or modality-specific charges.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 01490, its typical settings of use, and how it relates to nearby anesthesia codes for other lower leg procedures. The publication outlines billing benchmarks and common reporting considerations, summarizes payer coverage patterns, and situates 01490 within the broader anesthesia code set for lower extremity services. The content is intended to inform coding accuracy, clinical billing workflows, and payer contract review at a national level.
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Billing Code Overview
CPT code 01490 describes anesthesia services provided for the application, removal, or repair of a lower leg cast. The service type is anesthesia for lower leg cast procedures. The typical site of service is an outpatient procedure area or ambulatory surgical center where cast application, removal, or repair is performed, and may also occur in an emergency department or inpatient bedside when clinically indicated.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with symptomatic unilateral knee osteoarthritis of the right knee (M17.11) who previously underwent arthroscopic meniscal repair for a medial meniscus tear (S83.241A) presents with a painful, malodorous short leg cast that requires removal and replacement under monitored anesthesia care. The patient has chronic knee instability (M23.50) and prior immobilization after an open lower leg procedure. The procedure is performed in an ambulatory surgical center or hospital operating room where the anesthesia provider (Certified Registered Nurse Anesthetist) administers sedation or general anesthesia to facilitate safe manipulation, application, removal, or repair of a lower leg cast below the knee. The clinical workflow includes a pre-anesthesia assessment, intraoperative monitoring during the cast procedure, airway and hemodynamic management, and immediate post-anesthesia recovery. Documentation includes indication for anesthesia, anesthetic technique, pre-procedure vitals and ASA physical status, intra-procedure medications and monitoring, any intraoperative complications or use of modifiers (for example, prolonged services or concurrent procedures), and post-anesthesia recovery and discharge instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
23 | Unusual anesthesia provided where general anesthesia is administered but the procedure is normally done with local or no anesthesia | Use when general anesthesia is required for 01490 because the cast procedure otherwise would not require general anesthesia |
50 | Bilateral procedure | Use if bilateral lower leg casts are applied or removed and payer requires bilateral reporting |
52 | Reduced services | Use when the anesthesia service is partially reduced or a planned portion of the service is not performed |
53 | Discontinued procedure | Use when the anesthesia service is started but the cast procedure is aborted for clinical reasons |
55 | Postoperative management only | Use when anesthesia provider only performs postoperative care for another anesthesia team’s intraoperative services |
62 | Two surgeons — different specialty | Use when two qualified anesthesia professionals are required for complex co-managed procedures during the same encounter |
78 | Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period | Use when repeat cast application/removal occurs emergently in the immediate postoperative period |
AA | Anesthesia services performed personally by an anesthesiologist | Use when an MD anesthesiologist personally performs the anesthesia for the cast procedure |
AD | Medical supervision by anesthesiologist; medically directed team | Use when an anesthesiologist medically directs a team of qualified anesthetists during the cast procedure |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use when one anesthesiologist directs multiple concurrent anesthesia services including 01490 |
QS | Monitored anesthesia care (MAC) service | Use when the provider documents MAC for the cast application or removal |
QX | CRNA service with medical direction by a physician | Use when a CRNA performs the anesthesia under physician direction |
QY | Medical direction of one CRNA by an anesthesiologist | Use when an anesthesiologist directs one CRNA for the case |
FY | Diagnosis related group (DRG) exempt | Use for institutional reporting when applicable to payer billing |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
367500000X | Certified Registered Nurse Anesthetist | Primary provider taxonomy for anesthesia services in ambulatory and inpatient settings |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M23.50 | Chronic instability of knee, unspecified knee | Knee instability can lead to recurrent injury and need for immobilization or cast application managed under anesthesia |
M17.11 | Unilateral primary osteoarthritis, right knee | Osteoarthritis may contribute to deformity or pain requiring cast application, manipulation, or removal under anesthesia |
M17.12 | Unilateral primary osteoarthritis, left knee | Same clinical relevance for the left knee as above when immobilization is required |
S83.241A | Other tear of medial meniscus, current injury, right knee, initial encounter | Meniscal tears often lead to post-procedural immobilization with casts that may require anesthesia for safe application or removal |
S83.242A | Other tear of medial meniscus, current injury, left knee, initial encounter | Same relevance for the left knee meniscal injury requiring cast management under anesthesia |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01480 | Under anesthesia for procedures on the lower leg (below knee) – open procedure on bones of lower leg, ankle, and foot | May be used instead of 01490 when an open bony procedure is performed rather than cast application/removal |
01482 | Under anesthesia for procedures on the lower leg (below knee) – procedure on bones including radical resection (including below knee amputation) | Related when a more extensive bone procedure or amputation necessitates anesthesia beyond cast management |
01484 | Under anesthesia for procedures on the lower leg (below knee) – osteotomy or osteoplasty of tibia and/or fibula | Applicable when surgical osteotomy is performed in the same operative episode as cast application or replacement |
01486 | Under anesthesia for procedures on the lower leg (below knee) – total ankle replacement | Relevant when an ankle arthroplasty is performed and anesthesia services cover both the operative procedure and subsequent cast application |
01500 | Under anesthesia for procedures on the lower leg (below knee) – procedure on arteries including placement of bypass graft | Related when vascular procedures of the lower leg are performed and anesthesia billing must reflect the more complex vascular service alongside cast management |