Summary & Overview
CPT 00192: Anesthesia for Radical Facial Bone or Skull Surgery
CPT code 00192 covers anesthesia for radical surgical procedures on facial bones or the skull, including operations addressing prognathism. This code is significant for its application in complex craniofacial surgeries, where specialized anesthesia care is essential for patient safety and surgical outcomes. Nationally, the code is recognized by major commercial payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage for these advanced procedures.
This publication provides a comprehensive overview of CPT code 00192, including payer coverage, clinical context, and policy benchmarks. Readers will gain insight into the typical outpatient hospital setting where these services are rendered, as well as the importance of anesthesia in facilitating radical facial and skull surgeries. The analysis also highlights relevant modifiers, provider taxonomies, and associated diagnoses, offering a clear understanding of billing and clinical considerations. Policy updates and reimbursement trends are discussed to inform stakeholders about current practices and expectations in anesthesia billing for craniofacial surgery.
Healthcare professionals, administrators, and policy analysts will find this summary useful for understanding the scope and significance of CPT code 00192 in the national landscape, including payer policies and clinical benchmarks for anesthesia services in radical facial and skull procedures.
CPT Code Overview
CPT code 00192 is used to report anesthesia services for radical surgical procedures involving the facial bones or skull, including surgeries for prognathism. This code is specific to anesthesia care provided during complex craniofacial operations. The typical site of service for procedures billed under CPT code 00192 is an outpatient hospital setting, designated as Place of Service 22. The service type is anesthesia, reflecting the critical role of anesthesiology professionals in ensuring patient safety and comfort during these advanced surgical interventions.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient hospital setting for radical surgery involving the facial bones or skull, such as procedures to correct prognathism (abnormal protrusion of the jaw). The anesthesia team, which may include an anesthesiology physician or a certified registered nurse anesthetist (CRNA), provides anesthesia services for the duration of the surgery. The clinical workflow involves preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative care. The procedure is typically performed for patients requiring extensive surgical intervention on facial bones or the skull, often due to congenital abnormalities, trauma, or disease.
Coding Specifications
Common 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.
Associated Provider Taxonomies:
| Taxonomy Code | Specialty Description |
|---|---|
207L00000X | Anesthesiology Physician |
367500000X | Certified Registered Nurse Anesthetist (CRNA) |
207W00000X | Ophthalmology Physician |
These taxonomies represent the specialties eligible to provide or direct anesthesia services for this procedure.
Related Diagnoses
-
H25.9- Unspecified age-related cataract: Relevant for patients undergoing surgery where cataract is a comorbidity or part of the surgical indication. -
H26.9- Unspecified cataract: Indicates the presence of cataract, which may be associated with facial or skull procedures, especially if ocular involvement is present. -
H27.1- Dislocation of lens: May be clinically relevant if the surgical procedure involves correction of lens dislocation as part of facial or skull surgery. -
H28- Cataract in diseases classified elsewhere: Used when cataract is secondary to another disease, potentially relevant in complex surgical cases. -
H52.4- Presbyopia: Indicates age-related changes in vision, which may be considered during preoperative assessment for facial or skull surgery.
Each diagnosis code reflects conditions that may be present in patients undergoing radical surgery on facial bones or skull, either as primary indications or comorbidities.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
00190 | Anesthesia for procedures on facial bones or skull; not otherwise specified | Used for anesthesia services for less extensive or unspecified procedures on facial bones or skull. May be used as an alternative to 00192 when the surgery is not radical or does not include prognathism. |
00190 is commonly used as an alternative to 00192 for procedures that do not meet the criteria for radical surgery.
National Reimbursement Benchmarks
National mean rates for CPT code 00192 show that commercial payers such as Aetna, Blue Cross Blue Shield, Cigna, and BUCA (average commercial) reimburse at significantly higher levels than UnitedHealth Group. The mean rate for BUCA is $228.53, while UnitedHealth Group is much lower at $65.60. Medicare rates are not available in the input for comparison.
Rate dispersion varies notably across payers. Blue Cross Blue Shield has the tightest range between the 75th and 25th percentiles ($497.00 - $279.75 = $217.25), indicating more consistent reimbursement. Cigna displays the widest spread ($609.00 - $88.75 = $520.25), suggesting greater variability in rates. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 00192, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($252.50), while Aetna and UnitedHealth Group have minimal spread ($0 and $4, respectively). This indicates significant variability in payment levels depending on the payer, with some offering consistently low rates and others much higher, especially at the upper percentiles.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are substantially higher, while Cigna and UnitedHealth Group are closer to national levels. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these differences and the overall distribution.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00192 in Alaska, with a mean rate of $485.10.
- UnitedHealth Group offers the lowest mean rate at $75.12.
- Alaska's mean rates for most payers are notably higher than national averages, especially for Blue Cross Blue Shield and BUCA.
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.