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    v1.0.28
    OpenPayerBilling CodesAnesthesia for Obstetric ProceduresCPT cpt-01967-neuraxial-anesthesia-planned-vaginal-delivery
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    CPT 01967: Neuraxial Anesthesia for Planned Vaginal Delivery

    Commercial payers pay $115 on average nationally for this procedure.

    CPT code 01967 describes neuraxial anesthesia services provided for a patient undergoing a planned vaginal delivery; this represents intraoperative regional anesthesia management (such as spinal or epidural) for obstetric labor and delivery and is typically performed in a labor and delivery unit or operating room when neuraxial anesthetic care is required for a planned vaginal birth.

    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

    For CPT 01967 the average commercial benchmark (BUCA) sits at $115.30, providing a convenient midpoint for national comparisons across carriers. Blue Cross Blue Shield shows a relatively narrow interquartile spread (P75–P25 = $125.00 − $49.20 = $75.80), while UnitedHealth Group is the tightest among major carriers with an interquartile range of $80.90 − $52.00 = $28.90. Aetna and Cigna display wider dispersion, with Aetna’s IQR at $286.90 − $102.60 = $184.30 and Cigna’s at $160.00 − $75.60 = $84.40, indicating greater variability in contracted commercial rates for this code.

    Looking at central tendency, Blue Cross Blue Shield and UnitedHealth Group cluster below the BUCA mean, with medians of $72.00 and $63.80 respectively, while Aetna and Cigna have higher medians of $164.30 and $111.00. The range between payers’ upper quartiles further highlights market fragmentation: Aetna’s P75 at $286.90 sits well above other carriers’ P75s (Cigna $160.00, Blue Cross Blue Shield $125.00, UnitedHealth Group $80.90), suggesting the potential for outlier high commercial rates at some contracts.

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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 gravida 1 para 0 woman at 39 weeks gestation is admitted in active labor for a planned vaginal delivery. She requests neuraxial analgesia for labor pain management. The anesthesiology team evaluates her medical history (no coagulopathy, platelet count normal, no active infection at insertion site), obtains informed consent, and performs standard monitoring (continuous fetal monitoring, maternal pulse oximetry, noninvasive blood pressure, ECG). An epidural or combined spinal-epidural is placed in the labor and delivery unit by an anesthesiologist or a certified registered nurse anesthetist. After test dosing and confirmation of correct catheter placement, local anesthetic with or without opioid is administered to provide neuraxial anesthesia for labor and vaginal delivery. Documentation includes indication (e.g., labor pain), procedure performed (01967), level of the block, patient response, medications and doses administered, monitoring of maternal and fetal status, and any complications (hypotension, inadequate block, dural puncture). If an urgent cesarean delivery becomes necessary after neuraxial placement, conversion to surgical anesthesia is documented and may involve coding considerations distinct from 01967.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    01968Anesthesia for cesarean delivery following neuraxial anesthetic

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    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…
    47Modifier -47 (“Anesthesia by Surgeon”) is appended to a surgical or procedural CPT code when the surgeon personally provides regional or general anesthesia for the procedure. Use of -47 indicates the…- Use modifier -47 when the surgeon personally provides regional or general anesthesia during the surgical procedure (i.e., the surgeon administers the anesthesia in addition to performing the…
    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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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…
    99Modifier 99 is a placeholder modifier used when more modifiers apply to a single procedure than the claim form or electronic field allows. The AMA classifies it under Provider Services and Ambulatory…- Use CPT modifier -99 when more modifiers apply to a single procedure line than the claim form or payer field allows (CMS/Noridian: when more than four modifiers are needed); append modifier 99 on…

    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…
    207RA0201XAllergy & Immunology (Internal Medicine) PhysicianAn internist doctor of osteopathy that specializes in the treatment of allergy and immunologic disorders. A doctor of osteopathy that is board eligib…
    2084D0003XDiagnostic Neuroimaging (Psychiatry & Neurology) PhysicianA licensed physician, who has completed a residency program in Neurology, and who has additional training, experience, and competence in the standards…
    261QS0132XOphthalmologic Surgery Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    251B00000XCase Management AgencyAn organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access…
    224L00000XPedorthistAn individual who is trained in the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, a…

    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-01965-ANESTHESIA-FOR-INCOMPLETE-MISSED-ABORTION

    CPT 01965: Anesthesia for Incomplete or Missed Abortion

    CPT-01966-ANESTHESIA-FOR-INDUCED-ABORTION

    CPT 01966: Anesthesia for Induced Abortion Procedure

    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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    Used when a neuraxial anesthetic initially placed for labor or vaginal delivery is converted to anesthesia for cesarean delivery; documents the intraoperative anesthetic for the cesarean.