CPT 00142 Reimbursement Benchmarks & Policy | OpenPayer

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00142anesthesiologyophthalmologylens surgeryoutpatient hospitalmedical billinganesthesia carecataract surgeryclinical codingpolicy update

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

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`

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: Alaska1 / 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.

CPT 00210: Anesthesia for Unspecified Intracranial Procedures

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

CPT 00164: Anesthesia for Nasal and Sinus Soft Tissue Biopsy

00220-ANESTHESIA-FOR-INTRACRANIAL-PROCEDURES-NOT-OTHERWISE

CPT 00220: Anesthesia for Intracranial Procedures, Not Otherwise Specified

00192-ANESTHESIA-FOR-PROCEDURES-ON-FACIAL-BONES-OR-SKULL-RADICAL

CPT 00192: Anesthesia for Radical Facial Bone or Skull Surgery

00148-ANESTHESIA-FOR-EYE-EXAMINATION-USING-AN

CPT 00148: Anesthesia for Eye Examination Using Endoscope

00144-ANESTHESIA-FOR-PROCEDURES-ON-EYE-LENS

CPT 00144: Anesthesia for Eye Lens Surgery

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

CPT 00222: Anesthesia for Intracranial Head Procedures

00174-ANESTHESIA-FOR-PROCEDURES-ON-EYE-LENS

CPT 00174: Anesthesia for Eye Lens Surgery

00160-ANESTHESIA-FOR-PROCEDURES-ON-NOSE-AND-ACCESSORY-SINUSES-NOT

CPT 00160: Anesthesia for Nose and Sinus Procedures

00103-ANESTHESIA-FOR-RECONSTRUCTIVE-PROCEDURES-OF-EYELID-EG

CPT 00103: Anesthesia for Reconstructive Eyelid Procedures

Showing 1–10 of 30

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.

Taxonomy Code	Specialty Name
`207L00000X`	Anesthesiology
`207LA0401X`	Anesthesiology Assistant
`367500000X`	Certified Registered Nurse Anesthetist

OpenPayer

Summary & Overview

CPT 00142: Anesthesia for Eye Lens Surgery

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