Summary & Overview
CPT 00102: Anesthesia for Plastic Repair of Cleft Lip
CPT code 00102 covers anesthesia services for plastic repair of cleft lip, a critical procedure in pediatric and reconstructive surgery. This code is widely recognized across the United States and is used to ensure proper billing and reimbursement for anesthesia care during cleft lip repair. The service is typically delivered in hospital or ambulatory surgical center settings, reflecting the complexity and clinical importance of the procedure.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for services billed under CPT code 00102. Understanding payer policies and benchmarks for this code is essential for providers, billing teams, and healthcare administrators seeking to optimize compliance and reimbursement.
This publication offers a comprehensive overview of CPT code 00102, including its clinical context, typical sites of service, and associated billing practices. Readers will gain insight into payer coverage, relevant modifiers, and related codes, as well as current policy updates and benchmarks. The analysis is designed to support informed decision-making and accurate documentation for anesthesia services in cleft lip repair procedures.
CPT Code Overview
CPT code 00102 is designated for anesthesia services involving plastic repair of cleft lip. This procedure is typically performed by specialists in anesthesiology to ensure patient comfort and safety during surgical correction of cleft lip. The service is most commonly provided in a hospital or ambulatory surgical center setting, often corresponding to place of service codes 21 or 24. This code is essential for accurately documenting and billing anesthesia care associated with reconstructive plastic surgery for cleft lip.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a pediatric patient presenting with a congenital cleft lip requiring surgical repair. The procedure is performed in a hospital or ambulatory surgical center, often under general anesthesia. The anesthesiology team, which may include a physician anesthesiologist or a Certified Registered Nurse Anesthetist (CRNA), provides anesthesia services throughout the plastic repair of the cleft lip. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care in the recovery area.
Coding Specifications
-
Modifiers:
-
QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia. -
QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia services under the medical direction of a physician anesthesiologist.
-
-
Provider Taxonomies:
Taxonomy Code Specialty Description 207L00000XAnesthesiology 207LA0401XPain Medicine (Anesthesiology) 367500000XCertified Registered Nurse Anesthetist
These taxonomies represent providers specializing in anesthesiology, pain medicine within anesthesiology, and CRNAs.
Related Diagnoses
-
K11.9: Disease of salivary gland, unspecified- Relevant for patients with undiagnosed or unspecified salivary gland conditions, which may require surgical intervention and anesthesia.
-
K11.5: Sialolithiasis- Indicates the presence of salivary gland stones. While not directly related to cleft lip repair, this diagnosis may be present in patients undergoing oral or facial surgery.
-
K11.8: Other specified diseases of salivary glands- Covers other specific salivary gland diseases that may necessitate surgical procedures requiring anesthesia.
These diagnoses are associated with procedures in the oral and facial region, which may overlap with the clinical context of cleft lip repair and anesthesia services.
Related CPT Codes
-
00100: ANESTHESIA PX ON SALIVARY GLANDS WITH BIOPSY- Used for anesthesia services during procedures involving biopsy of the salivary glands. May be performed in similar surgical settings as cleft lip repair but is specific to salivary gland procedures.
-
00103: ANESTHESIA RECONSTRUCTIVE PROCEDURES OF EYELID- Used for anesthesia during reconstructive eyelid surgeries. This code is related as both involve anesthesia for facial reconstructive procedures, but each is specific to the anatomical site.
-
00104: ANESTHESIA ELECTROCONVULSIVE THERAPY- Used for anesthesia during electroconvulsive therapy. This code is an alternative for procedures involving ECT, not typically used with cleft lip repair but included as a related anesthesia code.
These codes are alternatives or related to 00102 based on the anatomical site or type of procedure. They are not commonly used together but may be selected depending on the surgical intervention.
National Reimbursement Benchmarks
National mean rates for CPT code 00102 show significant variation between commercial payers. Cigna and Blue Cross Blue Shield have the highest mean rates at $350.90 and $325.74, respectively, while UnitedHealth Group is notably lower at $65.65. The BUCA average commercial mean rate stands at $164.37, which is less than half of Cigna's mean rate. Medicare data is not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Cigna ($430.50) and Aetna ($345.00), indicating substantial variability in contracted rates. UnitedHealth Group has the tightest range ($25.67), suggesting more consistent reimbursement levels. Blue Cross Blue Shield and BUCA also show moderate dispersion, with ranges of $185.43 and $198.42, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 00102, with Blue Cross Blue Shield showing the largest rate spread (75th percentile minus 25th percentile) at $212.83, indicating substantial variability in payments. In contrast, Aetna and UnitedHealth Group have minimal rate spreads, with all percentiles clustered closely around $72, suggesting consistent but lower reimbursement levels. Cigna's rates are also tightly grouped, with a spread of only $8.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and Aetna are significantly higher, while UnitedHealth Group's mean rate remains below the national benchmark. The table and chart below present the full breakdown of payer-specific reimbursement rates in Alaska for CPT code 00102.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00102 in Alaska, with a mean rate of $419.24.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
- Alaska's mean rates for most payers, especially Blue Cross Blue Shield, are notably higher than national benchmarks, except for UnitedHealth Group, which remains low.
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.