CPT Code 01274: Anesthesia for upper leg arterial procedures

Key takeaways

CPT code 01274 covers anesthesia for procedures on the arteries of the upper leg, including bypass graft and femoral artery embolectomy.

The code carries 6 base units, and payment follows the formula (base units + time units + qualifying circumstances) x conversion factor.

Modifier choice follows the provider arrangement. Use AA when an anesthesiologist works alone, QZ for an independent nurse anesthetist, and QK or QX under medical direction.

Neighboring codes 01270 and 01272 carry different base units, so the code you pick changes what the claim pays.

Practice management software like Pabau helps anesthesia billing teams track modifiers, document qualifying circumstances, and submit cleaner claims.

CPT code 01274 covers anesthesia for procedures involving the arteries of the upper leg, including bypass graft and femoral artery embolectomy. It carries 6 base units, and every claim runs through the standard anesthesia payment formula.

The code sits in the anesthesia range 01200 to 01274, which covers the upper leg but excludes the knee. The American Medical Association (AMA) publishes the CPT code set and assigns 01274 to arterial work specifically.

This reference covers the base units, the payment formula, modifier rules, qualifying circumstances, documentation requirements, and the neighboring codes billers confuse with 01274.

CPT code 01274: Definition and clinical description

CPT code 01274 describes anesthesia for procedures involving arteries of the upper leg, including bypass graft and femoral artery embolectomy. The official AMA description reads: Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery, embolectomy. The NIH Value Set Authority Center confirms the code is active in CPT version 2024 and has not been retired or superseded.

Procedures covered: Femoral artery embolectomy, femoral-popliteal bypass graft, femoral artery endarterectomy, and other open arterial procedures on the upper leg. These are vascular surgery cases, typically requiring general or neuraxial anesthesia with intensive intraoperative monitoring.

What 01274 does not cover: Procedures involving the knee joint itself, which use codes in the 01380 to 01404 range. It also excludes endovascular femoral artery procedures and diagnostic angiography without a concurrent surgical procedure.

Base units and the anesthesia billing formula

CPT 01274 carries 6 base units in the CMS anesthesia base unit file, and state Medicaid schedules follow the same value. Base units reflect the complexity of the anesthesia service itself, independent of how long the case runs.

The neighboring arterial codes in this range do not share that value, so pull the number per code rather than assuming it. Practices that pre-load base units by code in their practice management software stop re-entering the figure on every claim.

The standard anesthesia reimbursement formula, mandated by the CMS Physician Fee Schedule, applies to CPT 01274:

Time units start when the anesthesiologist or certified registered nurse anesthetist (CRNA) takes responsibility for the patient. They end once the patient is safely transferred to post-anesthesia care. Document start and stop times to the minute on every case.

Medicare reimbursement and the anesthesia conversion factor

Medicare reimbursement for CPT 01274 is not a single national rate. The CMS Physician Fee Schedule applies a Geographic Practice Cost Index (GPCI) adjustment to every anesthesia payment. The dollar amount a practice receives therefore depends on its locality. Urban markets with higher practice costs (Manhattan, San Francisco) produce higher allowables than rural localities.

Key factors that affect the Medicare payment for CPT 01274:

• Geographic locality: GPCI modifies the conversion factor by locality. Check the CMS Physician Fee Schedule lookup for the applicable Medicare Administrative Contractor (MAC) jurisdiction.
• Provider type modifier: The AA modifier (anesthesiologist personally performs) receives 100% of the allowable. Medical direction modifiers (QK/QX/QY) are typically paid at different rates. QZ (independent CRNA) is also paid at 100% in most localities.
• Facility vs. non-facility: Anesthesia codes are almost always billed in a facility setting. Non-facility rates are rarely applicable.
• Annual CF updates: CMS updates the anesthesia conversion factor each January. Any rate stated in training materials or older fee schedule tables may be out of date. Always verify against the current CMS fee schedule.

Billing teams handling high volumes of vascular surgery work should build locality-specific benchmarks for 01274 rather than working from national averages. Pull the figure from your own MAC’s published fee schedule each January, and update the charge master when it moves.

Modifiers and provider-type rules

Modifier selection is the most common source of denied claims on CPT 01274. The modifier tells Medicare who delivered the anesthesia care and under what supervision arrangement. A modifier that misstates that arrangement creates compliance exposure on top of the payment error.

Medical direction rules and the seven CMS conditions

To bill a medical direction modifier (QK or QY), the directing anesthesiologist must satisfy all seven CMS conditions on the same case. Failing any single condition disqualifies medical direction billing for that case. CMS treats the seven as requirements, so partial compliance earns nothing.

• Performs a pre-anesthesia examination and evaluation of the patient
• Prescribes the anesthesia plan
• Is present for the most demanding procedures in the anesthesia plan, including induction and emergence
• Ensures that any procedures in the anesthesia plan that the CRNA performs are ones a CRNA is authorized to perform
• Monitors the course of anesthesia at frequent intervals
• Remains physically present and available for immediate diagnosis and treatment of emergencies
• Provides indicated post-anesthesia care

Practices billing large volumes of medically directed cases benefit from a structured attestation checklist inside the billing workflow. One template, filled in on every case, is easier to defend than free-text notes.

Documentation requirements before you bill

Anesthesia claims for CPT 01274 need a complete documentation trail, from the pre-procedure evaluation through to the post-anesthesia note. CMS Claims Processing Manual requirements apply to every Medicare claim. A missing element can trigger a denial, or a recoupment demand in a post-payment audit. Standardized medical forms make that trail easier to hold together across a full surgical schedule.

• Pre-anesthesia evaluation: Documents patient medical history, physical status (ASA classification), airway assessment, and the planned anesthetic approach. Must be completed before the procedure.
• Anesthesia care plan: The documented plan agreed between the anesthesiologist and, where applicable, the CRNA. Required for medical direction claims.
• Intraoperative anesthesia record: Continuous vital signs, drugs administered with doses and times, anesthesia start and stop times, and monitoring modalities used.
• Post-anesthesia note: Patient status on transfer from the operating room to the recovery unit, plus any complications. Must be completed before the patient leaves the anesthesia provider’s care.
• Qualifying circumstance documentation: If billing a QC code (99100, 99116, 99135, or 99140), the clinical justification must be explicit in the record.

For commercial payers, confirm the surgeon’s authorization is on file before the anesthesia claim goes out. A completed prior authorization form gives you something to point at when the payer asks.

Anesthesia records hold protected health information, so storage and transmission fall under HIPAA compliance rules. Platforms with structured EHR integration pull the record straight into the billing workflow, which cuts transcription errors and missing-field denials.

Qualifying circumstances that add units

Qualifying circumstance (QC) codes add units to the anesthesia billing formula when specific clinical conditions are present. They are not automatic additions. Each requires documented clinical justification in the anesthesia record.

For femoral artery embolectomy, 99140 applies often, because these cases frequently arrive urgently. The surgeon still has to certify the emergency in writing. 99116 and 99135 are separate circumstances, so bill the one the record actually supports.

Related CPT codes in the upper leg anesthesia range

Coders working on upper leg vascular and orthopedic cases need to distinguish CPT 01274 from adjacent codes. The selection depends entirely on the specific procedure being performed, not on the anatomical location alone.

The three codes do not share a base unit value. 01270 carries 8 units, 01272 carries 4, and 01274 carries 6, so the code you pick changes what the claim pays. Code selection also drives medical necessity alignment and audit defensibility.

Use the AAPC Codify CPT lookup to cross-check descriptions when the operative report is ambiguous. Anesthesia can decide code selection outside this range too. CPT 15851 covers suture removal that requires anesthesia.

Common billing errors and compliance tips

A handful of error patterns account for most denials and recoupments on vascular anesthesia claims. Each one is preventable at the pre-submission review step.

• Wrong modifier for the provider relationship: Billing AA when the anesthesiologist was actually directing two CRNAs is the most common compliance error. The billing modifier must match the actual care delivery arrangement documented in the anesthesia record.
• Missing anesthesia start/stop times: Time units are calculated from documented start and stop times. Claims submitted without clear time notation are frequently downcoded or denied by Medicare. Both times must appear in the anesthesia record and on the claim.
• Unbundling anesthesia from the surgical procedure: CPT 01274 is a global anesthesia code. Separately billing for monitoring, IV access, or other services included in the anesthesia global is an unbundling violation.
• QC codes without clinical documentation: Billing 99140 (emergency) without the surgeon’s written certification is the most audited QC claim error for 01274. The certification must be in the record before the claim is submitted.
• AD modifier on cases with 4 or fewer concurrent procedures: Modifier AD (more than 4 concurrent procedures) severely limits payment to three base units. Applying it in error on a normal medically directed case eliminates most of the legitimate reimbursement.

A pre-submission review step catches most of these before the claim reaches the payer. A short checklist that pairs the modifier with the documented provider arrangement does most of the work.

How Pabau supports anesthesia billing for CPT 01274

Most anesthesia billing teams keep the pieces of an 01274 claim in three places. Base units live in a spreadsheet, and the anesthesia record sits in the chart. The modifier is a decision someone makes from memory at charge entry.

Pabau holds them together. Its claims management software stores base units and modifier logic against the code. Structured medical notes keep anesthesia start and stop times where the biller can see them.

Surgical and specialty teams run the same setup, from plastic surgery practices to sports medicine clinics. Every subscription includes the full feature set, so billing, charting, and scheduling sit in one system.

The outcome is a shorter pre-claim review. Your team checks the modifier against the documented arrangement and confirms each qualifying circumstance is justified. The claim then goes out without anyone rebuilding the unit math by hand.

Reduce anesthesia billing errors before they become denials

Pabau helps anesthesia and surgical practices build pre-claim review workflows, track modifier compliance, and submit cleaner claims. See how it works for your team.

Book a demo

Conclusion

Two things decide whether an 01274 claim pays cleanly. The base unit value is 6, and the modifier has to match the provider arrangement the record documents.

The rest is discipline on the day. Log start and stop times to the minute, keep the surgeon’s emergency certification with the file, and re-check the conversion factor each January. Urgent vascular cases are exactly when that discipline slips, so make the checks part of charge entry rather than a monthly clean-up.

Pabau flags an incomplete anesthesia record before the claim leaves your queue. Book a demo to see how it handles modifier logic and unit math for surgical billing.

Continue your research

Billing a long reconstruction under general anesthesia? CPT 21159 walks through the coding rules for midface reconstruction.

Coding vascular work on the skin? CPT 17106 covers vascular lesion destruction and how treated area drives the claim.

Need the anesthesia rules for a minor procedure? CPT 15851 explains when suture removal becomes separately billable.

Billing an excision for a surgical practice? CPT 15835 shows how documentation supports a medically necessary excision.

Open treatment cases on your schedule? CPT 21470 covers a complicated mandibular fracture repair end to end.

Frequently asked questions