Summary & Overview
CPT 00142: Anesthesia for Eye Lens Surgery
CPT code 00142 represents anesthesia services for lens surgery procedures on the eye, a critical component in ophthalmic care. This code is widely used across the United States to ensure proper billing and reimbursement for anesthesia provided during surgeries such as cataract removal and lens implantation. The code is relevant for both routine and complex lens surgeries, reflecting its importance in the management of age-related and other types of cataracts.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, recognize and reimburse for CPT code 00142. The publication provides an overview of payer coverage, typical clinical scenarios, and the outpatient hospital setting where these services are most often delivered. Readers will gain insight into the clinical context of lens surgery anesthesia, common billing modifiers, associated provider taxonomies, and related diagnostic codes. The article also highlights related CPT codes for ophthalmic procedures, offering a comprehensive view of the billing landscape for eye surgeries.
This summary equips healthcare professionals, billing specialists, and policy analysts with essential information on CPT code 00142, including payer coverage, clinical relevance, and key benchmarks for anesthesia services in ophthalmology.
CPT Code Overview
CPT code 00142 is used to report anesthesia services for procedures on the eye, specifically lens surgery. This code falls under the anesthesiology service type and is most commonly performed in an outpatient hospital setting (Place of Service 22). The use of this code ensures accurate billing and documentation for anesthesia care provided during lens surgeries, which are frequently performed to address conditions such as cataracts and other visual impairments.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to an outpatient hospital setting for lens surgery due to visual impairment from cataracts. The patient may have a diagnosis such as unspecified age-related cataract or presbyopia, leading to decreased vision and difficulty with daily activities. The clinical workflow includes preoperative assessment, administration of anesthesia by an anesthesiologist, anesthesiology assistant, or certified registered nurse anesthetist, followed by the ophthalmic surgical procedure. Anesthesia is provided specifically for the lens surgery, ensuring patient comfort and safety throughout the operation.
Coding Specifications
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Modifier
QS: Indicates that monitored anesthesia care service was provided. Used when the anesthesia provider is present and monitoring the patient during the procedure, but not necessarily administering general anesthesia. -
Modifier
QX: Used when a certified registered nurse anesthetist (CRNA) provides anesthesia services with medical direction by a physician.
| Modifier Code | Description |
|---|---|
QS | Monitored anesthesia care service |
QX | CRNA service with medical direction by physician |
- Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Anesthesiology Assistant |
367500000X | Certified Registered Nurse Anesthetist |
These taxonomies represent the specialties eligible to provide and bill for anesthesia services for lens surgery.
Related Diagnoses
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H25.9: Unspecified age-related cataract- Indicates cataract formation due to aging, a common reason for lens surgery and anesthesia.
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H26.9: Unspecified cataract- Refers to cataracts not specifically age-related, also necessitating lens surgery.
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H52.4: Presbyopia- Age-related loss of near vision, may be addressed during lens surgery, especially when combined with cataract removal.
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H53.8: Other visual disturbances- Represents visual symptoms that may prompt evaluation and surgical intervention.
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H54.7: Unspecified visual loss- Used when the patient has vision loss without a more specific diagnosis, often leading to further investigation and possible lens surgery.
Each diagnosis is clinically relevant as it may justify the need for lens surgery and the associated anesthesia service (00142).
Related CPT Codes
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66984: Extracapsular cataract removal with insertion of intraocular lens prosthesis- Commonly performed in conjunction with anesthesia for lens surgery. This is the primary surgical procedure for cataract removal.
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66982: Complex cataract surgery with insertion of intraocular lens prosthesis- Used when the cataract surgery is more complex, often due to additional ocular conditions. Anesthesia is required for these cases as well.
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92015: Determination of refractive state- Performed preoperatively to assess the patient's refractive error and plan for intraocular lens selection. Not typically billed with anesthesia, but part of the overall workflow.
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92136: Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation- Used to calculate the appropriate intraocular lens power before surgery. This diagnostic procedure is part of the preoperative planning for lens surgery.
Codes 66984 and 66982 are commonly used together with anesthesia CPT code 00142 during cataract surgery. Codes 92015 and 92136 are used in the preoperative phase and are not alternatives to anesthesia, but support surgical planning.
National Reimbursement Benchmarks
National mean rates for CPT code 00142 show that Cigna, Blue Cross Blue Shield, and Aetna have the highest average reimbursement levels, with Cigna at $248.20, Blue Cross Blue Shield at $225.95, and Aetna at $200.25. UnitedHealth Group is notably lower at $65.62, while the BUCA average is $141.25. Medicare rates are not available in the input.
Rate dispersion varies significantly across payers. Blue Cross Blue Shield has the tightest range between the 25th and 75th percentiles ($120.00), indicating more consistent rates. Aetna and Cigna display much wider ranges ($294.00 and $259.00, respectively), suggesting greater variability in contracted rates. UnitedHealth Group and BUCA have moderate dispersion ($25.44 and $155.00).
The table and chart below present the full breakdown of national benchmarks for CPT code 00142 by payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 00142, with Blue Cross Blue Shield showing the largest rate spread between the 25th and 75th percentiles ($72.95), while Aetna and UnitedHealth Group have minimal spreads ($0.50 and $4.00, respectively). This indicates that Blue Cross Blue Shield's rates vary more across providers, whereas Aetna and UnitedHealth Group maintain consistent rates. Compared to national averages, Alaska's mean rates for most payers are notably higher, especially for BUCA and Blue Cross Blue Shield, suggesting a premium for anesthesia services in the state.
The table and chart below present the full breakdown of mean rates and percentile distributions by payer for Alaska, highlighting the differences in reimbursement across the major commercial insurers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 00142, with a mean rate of $269.04.
- 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 are higher than national benchmarks, especially for BUCA and Blue Cross Blue Shield.
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