CPT 01860: Anesthesia for Forearm, Wrist, or Hand Cast Application or Revision - OpenPayer

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Summary & Overview

CPT 01860: Anesthesia for Forearm, Wrist, or Hand Cast Application or Revision

CPT code 01860 covers anesthesia services provided for the application or revision of casts on the forearm, wrist, or hand. This procedure-specific anesthesia code matters nationally because it captures peri-procedural anesthesia resources for common orthopedic interventions in acute and outpatient settings. Accurate coding of 01860 affects provider billing, payer adjudication, and resource tracking for short, focused anesthesia encounters tied to cast application or reapplication.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service (operating room, procedure suite, ambulatory surgical center), and common operational considerations for documenting and billing anesthesia tied to cast procedures. The publication also summarizes typical modifiers reported with this service and highlights where input was not provided.

The report is intended to inform coding staff, anesthesia providers, and revenue cycle stakeholders about the clinical intent of the code, payer coverage considerations, and the types of benchmarks and policy topics that are typically relevant for this class of anesthesia services. Data not available in the input is signaled where applicable; the content focuses on the nationally relevant role of CPT code 01860 in peri-procedural billing for upper-extremity cast application and revision.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare01860CPTAnesthesiaOrthopedicsCast applicationHand surgeryWristForearmProcedure coding

Billing Code Overview

CPT code 01860 describes anesthesia services provided for forearm, wrist, or hand cast application or revision. The code applies when anesthesia is administered to facilitate the placement or reapplication of a cast on the forearm, wrist, or hand, including situations where the cast must be redone to meet specific clinical needs.

Service Type: Anesthesia for orthopedic cast application/revision

Typical Site of Service: Operating room, procedure suite, or ambulatory surgical center, depending on clinical need and facility capabilities.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or pediatric patient who presents to an ambulatory surgical center, emergency department, or orthopedic clinic for application or revision of a forearm, wrist, or hand cast following a closed distal radius, ulna, metacarpal, or phalangeal fracture, or for immobilization after soft-tissue injury. The patient may arrive after initial closed reduction in the emergency department or clinic, or return for cast revision due to poor fit, neurovascular compromise, excessive swelling, pressure areas, or planned conversion from a temporary splint to a definitive cast. The clinical workflow includes pre-procedure evaluation by the anesthesia team (medical history, ASA classification, airway assessment), informed consent for anesthesia, placement of appropriate anesthesia (monitored anesthesia care or regional block such as axillary or supraclavicular block or local infiltration with sedation), intra-procedural monitoring, participation during cast application or molding by the orthopedic provider, and post-anesthesia recovery with documentation of anesthetic type, drugs, and patient response. Typical sites of service are ambulatory surgical centers, hospital outpatient departments, emergency departments, and inpatient wards when the patient is admitted for associated injuries or comorbidities.

Coding Specifications

Modifier	Description	When to Use
`23`	Unusual Anesthesia	Use when general anesthesia is administered for a procedure that normally would not require it due to patient condition or procedure complexity during cast application or revision.

Taxonomy Code	Specialty	Notes
`2084P0406X`	Anesthesiology	Physicians providing general, regional, or MAC for cast application/revision.
`2084N0400X`	Nurse Anesthetist	CRNAs commonly administer regional blocks or MAC in ambulatory settings.
`207L00000X`	Orthopedic Surgery	Orthopedic surgeons or hand surgeons who perform the cast application and revisions.
`261QM0800X`	Emergency Medicine	Emergency physicians who may request anesthesia services for reduction and casting in ED.
`207RG0100X`	Plastic Surgery	Hand/upper extremity surgeons who may perform complex castings or revisions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S52.501A`	Unspecified fracture of the lower end of right radius, initial encounter for closed fracture	Common indication for forearm/wrist cast application or revision.
`S52.502A`	Unspecified fracture of the lower end of left radius, initial encounter for closed fracture	Same as above for the left side.
`S62.209A`	Unspecified fracture of unspecified carpal bone, initial encounter for closed fracture	Wrist fractures requiring immobilization with cast and possible anesthesia for reduction or revision.
`S62.201A`	Fracture of scaphoid bone, unspecified wrist, initial encounter for closed fracture	Scaphoid fractures commonly immobilized; may need anesthesia for reduction or casting.
`S62.900A`	Unspecified fracture of the hand, initial encounter for closed fracture	Hand fractures often require casting, sometimes with sedation or regional block.
`S63.501A`	Unspecified dislocation of right wrist, initial encounter	Dislocations reduced and immobilized with casting; anesthesia often used for closed reduction and casting.
`S62.306A`	Unspecified fracture of the fifth metacarpal bone, right hand, initial encounter	Metacarpal fractures frequently managed with cast or splint with anesthesia for manipulation.
`T14.90`	Injury of unspecified body region, unspecified	Used rarely when a more specific code is not available but immobilization is required.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`01860`	Anesthesia for procedures involving forearm, wrist, or hand cast application or revision	Primary anesthesia code describing services for cast application or revision of the forearm, wrist, or hand.
`20600`	Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, finger, toe)	May be performed before casting to reduce swelling or inject anesthetic in small joints prior to casting.
`25600`	Closed treatment of distal radial fracture (e.g., Colles or Smith type) without manipulation	Related orthopedic management that may be accompanied by anesthesia for cast application.
`25605`	Closed treatment of distal radial fracture; with manipulation	When reduction with manipulation is required prior to casting, anesthesia is commonly provided.
`29125`	Application of cast; forearm and elbow	Cast application codes for the actual casting procedure performed by orthopedics in conjunction with anesthesia services.
`29075`	Application of short arm cast (below elbow to hand)	Specific cast application code commonly billed by orthopedics when anesthesia is provided for comfort during molding.