CPT 00102 Reimbursement Benchmarks & Policy | OpenPayer

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00102anesthesiologyplastic repaircleft liphospitalambulatory surgical centermedical billingreconstructive surgeryprocedure coding

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

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: Alaska1 / 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.

CPT 00144: Anesthesia for Eye Lens Surgery

00176-ANESTHESIA-FOR-POSTERIOR-SEGMENT-EYE

CPT 00176: Anesthesia for Posterior Segment Eye Procedure

00212-ANESTHESIA-INTRACRANIAL-PROCEDURE-SUBDURAL

CPT 00212: Anesthesia for Intracranial Subdural Tap

00126-ANESTHESIA-FOR-INCISION-OF-EAR

CPT 00126: Anesthesia for Incision of Eardrum

00104-ANESTHESIA-FOR-ELECTROCONVULSIVE

CPT 00104: Anesthesia for Electroconvulsive Therapy

00124-ANES-EXTERNAL-MIDDLE-INNER-EAR-WBX

CPT 00124: Anesthesia for External, Middle & Inner Ear Biopsy with Otoscopy

00140-ANESTHESIA-FOR-PROCEDURES-ON-EYE-NOT-OTHERWISE

CPT 00140: Anesthesia for Unspecified Eye Procedures

00216-ANESTHESIA-INTRACRANIAL-PX-VASCULAR

CPT 00216: Anesthesia for Intracranial Percutaneous Vascular Procedures

00222-UNDER-ANESTHESIA-FOR-PROCEDURES-ON-THE-HEAD-INCLUDING

CPT 00222: Anesthesia for Intracranial Head Procedures

00164-ANESTHESIA-FOR-PROCEDURES-ON-NOSE-AND-ACCESSORY-SINUSES

CPT 00164: Anesthesia for Nasal and Sinus Soft Tissue Biopsy

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Summary & Overview

CPT 00102: Anesthesia for Plastic Repair of Cleft Lip

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes