CPT 00145: Anesthesia for Vitreoretinal Eye Surgery - OpenPayer

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Summary & Overview

CPT 00145: Anesthesia for Vitreoretinal Eye Surgery

CPT code 00145 is a critical billing code used for anesthesia services during vitreoretinal eye surgeries. These procedures are essential for treating a range of retinal and vitreous conditions, often requiring specialized anesthesia care to ensure patient safety and optimal surgical outcomes. The code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, making it relevant for providers and facilities nationwide.

This publication provides a comprehensive overview of 00145, including its clinical context, typical site of service, and its role in the broader landscape of ophthalmic surgery. Readers will gain insight into payer coverage, common billing modifiers, and associated diagnoses, as well as related CPT codes frequently billed alongside 00145. The analysis highlights current policy updates, reimbursement benchmarks, and the importance of accurate coding for anesthesia in outpatient hospital settings. By understanding the nuances of 00145, stakeholders can better navigate the complexities of medical billing and compliance for vitreoretinal surgical procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00145anesthesiologyvitreoretinal surgeryophthalmologyoutpatient hospitalmedical billingmodifier codesclinical contextpolicy updatesbenchmarking

CPT Code Overview

CPT code 00145 is designated for anesthesia services provided during procedures on the eye, specifically vitreoretinal surgery. This code falls under the anesthesiology service type and is most commonly utilized in the outpatient hospital setting (Place of Service 22). The use of this code ensures accurate billing and documentation for anesthesia care during complex ophthalmic surgeries involving the retina and vitreous body.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult presenting to an outpatient hospital setting for vitreoretinal surgery due to vision impairment from a cataract or related eye condition. The patient may have diagnoses such as unspecified age-related cataract, aphakia, or presbyopia. An anesthesiology physician or a certified registered nurse anesthetist (CRNA) provides anesthesia services during the procedure, ensuring patient comfort and safety throughout the surgery. The clinical workflow includes preoperative assessment, administration of anesthesia, monitoring during the procedure, and postoperative care.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when anesthesia is provided in a manner that allows the patient to remain responsive but comfortable during the procedure.
- QX: CRNA service with medical direction by a physician. Used when a CRNA administers anesthesia under the supervision of an anesthesiology physician.
Provider Taxonomies:

Taxonomy Code Specialty

National Reimbursement Benchmarks

National mean rates for CPT code 00145 show significant variation between commercial payers and Medicare. The average commercial rate (BUCA) is $190.04, while UnitedHealth Group, which is used as a proxy for Medicare in this context, has a much lower mean rate of $65.62.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies widely across payers. Blue Cross Blue Shield exhibits the tightest range ($161.46), indicating more consistent rates, while Aetna and Cigna have the widest dispersions ($482.00 and $430.00, respectively), reflecting greater variability in contracted rates. UnitedHealth Group and BUCA also show relatively narrow ranges ($25.47 and $242.28).

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 00145, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($536.00 minus $324.17 = $211.83), indicating substantial variability in negotiated rates. In contrast, Aetna, Cigna, and UnitedHealth Group display minimal rate spread, with all percentiles clustered closely together, suggesting more uniform payment structures.

Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are notably higher, while UnitedHealth Group and Cigna remain below national means. The table and chart below present the full breakdown of payer-specific rates in Alaska.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00145 in Alaska, with a mean rate of $419.13.
UnitedHealth Group offers the lowest mean rate at $75.12.
Alaska's mean rates for most payers are significantly higher than national averages, especially for Blue Cross Blue Shield and BUCA.

Related Codes

00300

CPT 00300: Anesthesia for Head, Neck and Posterior Trunk Procedures

00220

CPT 00220: Anesthesia for Intracranial Procedures, Not Otherwise Specified

00126

CPT 00126: Anesthesia for Incision of Eardrum

00350

CPT 00350: Anesthesia for Major Vessels of the Neck

00164

CPT 00164: Anesthesia for Nasal and Sinus Soft Tissue Biopsy

00142

CPT 00142: Anesthesia for Eye Lens Surgery

00124

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

00222

CPT 00222: Anesthesia for Intracranial Head Procedures

00218

CPT 00218: Anesthesia for Thoracic Spine and Spinal Cord Procedures

00214

CPT 00214: Anesthesia for Intracranial Burr Holes with Ventricular Access

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