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    v1.0.28
    OpenPayerBilling CodesAnesthesia for Obstetric ProceduresCPT cpt-01965-anesthesia-for-incomplete-missed-abortion
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    CPT 01965: Anesthesia for Incomplete or Missed Abortion

    Commercial payers pay $85 on average nationally for this procedure.

    CPT code 01965 describes anesthesia services provided for an incomplete or missed abortion procedure, typically representing intraoperative general or regional anesthesia administered by an anesthesia professional; service type: anesthesia for a gynecologic procedure; typical site of service: hospital operating room or ambulatory surgery center.

    For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.

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    National Reimbursement Benchmarks

    National commercial rates for CPT 01965 cluster around BUCA’s average commercial benchmark of $85, with notable variation across individual payers. Blue Cross Blue Shield’s midpoint sits lower than BUCA, Aetna’s distribution skews higher with a $279.70 maximum, and Cigna and UnitedHealth Group fall between those extremes. This positions BUCA as a useful average commercial reference amid a wide national spread.

    Dispersion measured by the interquartile range (P75 minus P25) highlights where rates are tightest or widest: Blue Cross Blue Shield shows a range of $49.8, UnitedHealth Group is the tightest at $28.9, while Aetna displays the widest dispersion at $79.0. Cigna’s IQR is $40.1 and BUCA’s is $52.0, indicating moderate variability around the BUCA average across payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 28-year-old female presents to the outpatient ambulatory surgery center with vaginal bleeding and cramping after a confirmed incomplete spontaneous abortion at 10 weeks gestation. She has stable vital signs but ongoing heavy bleeding and retained tissue on ultrasound. The obstetrics and gynecology team schedules an operative uterine evacuation (manual vacuum aspiration or dilation and curettage) under monitored anesthesia care. The anesthesia team — either an anesthesiologist (207L00000X) or a certified registered nurse anesthetist (367500000X) working with an OB/GYN (207V00000X) — performs anesthesia services documented as anesthesia for incomplete or missed abortion, reported with 01965.

    Pre-procedure workflow includes informed consent, review of allergies and medications, assessment of airway and comorbidities (ASA physical status documented), and establishment of intravenous access. Typical anesthesia care may consist of monitored anesthesia care with sedation or general anesthesia depending on patient factors, pain control needs, and procedure complexity. Intra-procedure documentation captures time in/out, agents administered, airway management, hemodynamic stability, and any complications. Post-procedure recovery occurs in the ambulatory post-anesthesia care unit with monitoring until discharge criteria are met. Coding of 01965 is performed by the anesthesia provider and may include applicable modifiers to indicate unusual circumstances, concurrent services, or provider qualifications.

    Related CPT Codes

    CPT Code

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    367500000XCertified Registered Nurse Anesthetist(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, prov…
    207V00000XObstetrics & Gynecology PhysicianAn obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproducti…
    172P00000XNaprapathNaprapathy means a branch of medicine that focuses on the evaluation and treatment of neuron-muscular conditions. Doctors of naprapathy are connectiv…
    156FX1101XOphthalmic AssistantAn ophthalmic assistant assists ophthalmologists by performing duties including, but not limited to, patient charting, patient education, and basic ey…
    2471S1302XSonography Radiologic TechnologistA radiologic technologist who specializes in sonography and is appropriately educated and trained, consistent with nationally recognized standards, st…
    221700000XArt Therapist(1) An individual who uses art to achieve the therapeutic goals of symptom relief, emotional integration, and recovery from or adjustment to illness o…
    364SP0810XChild & Family Psychiatric/Mental Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 2

    7 rows

    PolicyPayerEffective Date
    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-01958-ANESTHESIA-EXTERNAL-CEPHALIC-VERSION

    CPT 01958: Anesthesia for External Cephalic Version

    CPT-01960-ANESTHESIA-FOR-VAGINAL-DELIVERY

    CPT 01960: Anesthesia for Vaginal Delivery

    CPT-01961-ANESTHESIA-FOR-CESAREAN-DELIVERY

    CPT 01961: Anesthesia for Cesarean Delivery

    CPT-01962-URGENT-POSTPARTUM-HYSTERECTOMY-ANESTHESIA

    CPT 01962: Anesthesia for Urgent Postpartum Hysterectomy

    CPT-01963-CESAREAN-HYSTERECTOMY-ANESTHESIA

    CPT 01963: Anesthesia for Cesarean Hysterectomy

    CPT-01966-ANESTHESIA-FOR-INDUCED-ABORTION

    CPT 01966: Anesthesia for Induced Abortion Procedure

    CPT-01967-NEURAXIAL-ANESTHESIA-PLANNED-VAGINAL-DELIVERY

    CPT 01967: Neuraxial Anesthesia for Planned Vaginal Delivery

    CPT-01968-CESAREAN-DELIVERY-ANESTHESIA-AFTER-NEURAXIAL

    CPT 01968: Anesthesia for Cesarean Delivery After Neuraxial Anesthetic

    CPT-01969-CESAREAN-HYSTERECTOMY-AFTER-NEURAXIAL-ANESTHESIA

    CPT 01969: Anesthesia for Cesarean Hysterectomy After Neuraxial Anesthesia

    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
    01967Anesthesia for labor and vaginal deliveryMay be reported when anesthesia care transitions to labor analgesia or when procedures related to vaginal delivery require anesthesia; clinically adjacent but distinct from abortion services.
    01968Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesiaRelated for intrapartum conversions to cesarean delivery; not typically used for incomplete/missed abortion but relevant when obstetric escalation occurs.
    59510Routine obstetric care including antepartum care, cesarean delivery, and postpartum careRepresents global obstetric care bundle; relevant when cesarean delivery or full obstetric services are billed in the same episode but not a direct companion to 01965.
    59514Cesarean delivery onlyApplicable when cesarean delivery is performed and anesthesia services for cesarean are billed separately; included as related obstetric surgical code in workflows that escalate from uterine evacuation to cesarean.