CPT 01958: Anesthesia for External Cephalic Version
CPT code 01958 designates anesthesia services performed specifically for an external cephalic version (ECV), an obstetric procedure used to attempt to turn a breech fetus to a head-down position. This code is clinically important because anesthesia may facilitate maternal relaxation and procedural success while balancing maternal and fetal safety considerations. Nationally, accurate coding of anesthesia for ECV affects clinical workflows, anesthesia resource allocation in obstetric units, and payer coverage determinations.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication covers how these payers commonly address authorization and reimbursement for anesthesia related to ECV, and highlights common modifiers and coding relationships that influence claim adjudication.
Readers will find a concise clinical context for when 01958 is used, typical sites of service, and the common ICD-10 diagnoses associated with ECV for breech presentation. The report also summarizes related anesthesia codes for vaginal and cesarean delivery to clarify coding choices when multiple obstetric anesthesia services occur. Policy and billing implications relevant to national payers and hospital billing teams are summarized to support coding accuracy and claim consistency.
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Billing Code Overview
CPT code 01958 describes anesthesia services provided for an external cephalic version (ECV) procedure. The service type is anesthesia for an obstetric procedure, and the typical site of service is an inpatient or outpatient labor and delivery setting where ECV is performed to attempt fetal version from breech to cephalic presentation.
Clinical & Coding Specifications
Clinical Context
A 32-year-old G2P1 at 37 weeks gestation presents for an attempted external cephalic version (ECV) because the fetus remains in breech presentation noted on recent ultrasound. The procedure is scheduled in the obstetric unit with continuous fetal monitoring and immediate access to cesarean delivery resources. An obstetrician performs the version while an anesthesiologist provides anesthesia services coded as 01958.
Pre-procedure workflow includes confirmation of fetal presentation with ultrasound, maternal informed consent, baseline maternal vital signs, and electronic fetal monitoring. The anesthesiologist evaluates the patient for anesthesia options (e.g., neuraxial analgesia such as a single-shot spinal or epidural catheter top-up, or monitored anesthesia care with intravenous agents) and documents risks and plan. During the ECV, anesthesia may be used to provide maternal relaxation and analgesia, improve uterine relaxation with adjunctive tocolytics, and permit successful manipulation. Continuous maternal and fetal monitoring continues throughout. If ECV is successful, the patient is monitored and may proceed to planned vaginal delivery; if unsuccessful or if fetal distress occurs, the team proceeds to cesarean delivery with anesthesia transitioned to appropriate obstetric anesthesia code as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when anesthesia services require substantially greater work or time than usual for 01958, with documentation of reasons. |
23 | Unusual anesthesia for procedure | Use when general anesthesia is medically necessary for ECV due to extreme conditions when neuraxial/monitored anesthesia is not appropriate. |
52 | Reduced services | Use when the anesthesia service was partially reduced or truncated for 01958 (e.g., aborted attempt before full anesthesia delivered). |
53 | Discontinued procedure | Use when the anesthesia was initiated but the ECV was aborted for patient safety before completion. |
54 | Surgical care only | Use when the anesthesiologist provides only intraoperative care and another anesthesia provider bills for pre/postoperative care (rare for ECV). |
55 | Postoperative management only | Use when the anesthesiologist provides only postoperative management for anesthesia related to 01958. |
59 | Distinct procedural service | Use to indicate a distinct anesthesia-related service on the same day that is separate from other billed services when appropriate. |
62 | Two surgeons | Use when two anesthesia-qualified physicians are required concurrently for complex maternal conditions during ECV (rare). |
78 | Return to the OR following prior procedure | Use if an unplanned return for operative management (e.g., emergency cesarean after ECV) requires additional anesthesia services. |
AA | Anesthesia by anesthesiologist | Use to designate that a physician anesthesiologist personally performed the anesthesia service for 01958. |
AD | Medical supervision by a physician: more than four concurrent anesthesia procedures | Use when the anesthesiologist provides medical direction/supervision of multiple concurrent anesthesia procedures including the ECV. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for anesthesia care | Use when a qualified nonphysician anesthesia practitioner performs the service under appropriate supervision for 01958. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified nonphysician anesthetists | Use when the anesthesiologist directs multiple concurrent cases including the ECV. |
QS | Monitored anesthesia care (MAC) service | Use when MAC is provided during the ECV and is billed in conjunction with 01958 as applicable. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Primary specialty for physicians providing anesthesia for ECV (01958). |
207LA0401X | Pain Medicine (Anesthesiology) | Anesthesiologists with pain medicine training may provide MAC or analgesic techniques for ECV in complex patients. |
207LC0200X | Critical Care Medicine (Anesthesiology) | Critical care–trained anesthesiologists may be involved when maternal critical illness complicates ECV planning or during periprocedural management. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
O32.1XX0 | Maternal care for breech presentation, not applicable or unspecified | Primary indication for attempting external cephalic version; documents breech presentation when specific fetus not specified. |
O32.1XX1 | Maternal care for breech presentation, fetus 1 | Indicates breech presentation of fetus 1 in a multiple gestation — relevant when 01958 is provided for that fetus. |
O32.1XX2 | Maternal care for breech presentation, fetus 2 | Indicates breech presentation of fetus 2 in multiple gestation scenarios relevant to ECV planning. |
O32.1XX3 | Maternal care for breech presentation, fetus 3 | Indicates breech presentation of fetus 3 in higher-order multiple gestation; impacts decision-making for ECV and anesthesia. |
O32.1XX4 | Maternal care for breech presentation, fetus 4 | Indicates breech presentation of fetus 4 in quadruplet or higher-order gestation; relevant to risk assessment and anesthesia for ECV. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01960 | Anesthesia for vaginal delivery | May be billed for anesthesia services when a patient proceeds to vaginal delivery after successful ECV; distinct from ECV anesthesia 01958. |
01968 | Anesthesia for cesarean delivery (after neuraxial anesthetic) | Billed if ECV leads to cesarean delivery or if an emergent cesarean is required after attempted ECV; represents transition to operative obstetric anesthesia. |