CPT 00214: Anesthesia for Intracranial Burr Holes with Ventricular Access - OpenPayer

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Summary & Overview

CPT 00214: Anesthesia for Intracranial Burr Holes with Ventricular Access

CPT code 00214 covers anesthesia services for intracranial procedures involving burr holes with ventricular access, a critical component in neurosurgical care. This code is nationally recognized and utilized in outpatient hospital settings, reflecting its importance in facilitating safe and effective surgical interventions for conditions requiring ventricular access. The publication examines coverage and policy benchmarks from major payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer policies and reimbursement trends.

Readers will gain insight into the clinical context of 00214, including its role in neurosurgery, typical service environments, and associated billing practices. The summary also highlights relevant modifiers and taxonomies, offering clarity on coding nuances and professional classifications. Additionally, the publication outlines related CPT codes and common ICD-10 diagnoses linked to intracranial procedures, equipping stakeholders with a thorough understanding of the code's application and payer landscape. This resource is designed to inform healthcare professionals, administrators, and policy analysts about current standards and updates in anesthesia billing for intracranial procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00214anesthesiaintracranial proceduresburr holesventricular accessoutpatient hospitalmedical billingpolicy benchmarksclinical contextreimbursement

CPT Code Overview

CPT code 00214 is designated for anesthesia services during intracranial procedures involving burr holes with ventricular access. This code is used when anesthesia is provided for patients undergoing neurosurgical interventions that require the creation of burr holes and access to the ventricular system. The typical site of service for this procedure is an outpatient hospital setting, classified as Place of Service 22. As a specialized anesthesia code, 00214 is integral to ensuring patient safety and comfort during complex intracranial operations.

Clinical & Coding Specifications

Clinical Context

A patient presents to the outpatient hospital with symptoms suggestive of increased intracranial pressure or hydrocephalus, such as headache, nausea, or altered mental status. The neurosurgical team determines that an intracranial procedure involving burr holes with ventricular access is necessary, often for the placement of a ventricular drain or shunt. An anesthesiologist provides anesthesia services throughout the procedure, ensuring patient safety and comfort. The workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative care in the recovery area. The procedure is typically performed by providers specializing in anesthesiology, pain medicine (anesthesiology), or pediatric anesthesiology, depending on patient age and complexity.

Coding Specifications

Modifiers:

Modifier Code Description Usage
QS Monitored anesthesia care service Used when anesthesia is provided as monitored anesthesia care rather than general anesthesia.
P1 A normal healthy patient

Modifier Code	Description	Usage
`QS`	Monitored anesthesia care service	Used when anesthesia is provided as monitored anesthesia care rather than general anesthesia.
`P1`	A normal healthy patient

National Reimbursement Benchmarks

National mean rates for CPT code 00214 show significant variation between payers. The average commercial rate (BUCA) is $231.19, which is substantially higher than the UnitedHealth Group mean rate of $65.47. Among the major commercial payers, Cigna and Blue Cross Blue Shield have the highest mean rates at $500.10 and $487.87, respectively, while Aetna is lower at $320.38.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies widely. UnitedHealth Group has the tightest range ($24.83), indicating less variability in rates, while Cigna exhibits the widest range ($690.50), reflecting significant rate spread. Blue Cross Blue Shield and Aetna also show considerable dispersion, with ranges of $288.42 and $535.75, respectively. The table and chart below present the full breakdown of national benchmarks for this code.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska demonstrates a substantial rate spread for CPT code 00214, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $330.60 ($800.00 minus $469.40). BUCA also shows a wide spread of $360.80, while Aetna, Cigna, and UnitedHealth Group have much narrower spreads, all under $21.00. This indicates significant variability in reimbursement depending on payer, with some offering consistently low rates and others much higher.

Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably higher, while Aetna, Cigna, and UnitedHealth Group are closer to or slightly above their national benchmarks. The table and chart below present the full breakdown of payer-specific rates and percentiles for Alaska.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00214 in Alaska, with a mean rate of $617.30.
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 BCBS and BUCA, are notably higher than their respective national averages, indicating a premium reimbursement environment.

Related Codes

00220

CPT 00220: Anesthesia for Intracranial Procedures, Not Otherwise Specified

00218

CPT 00218: Anesthesia for Thoracic Spine and Spinal Cord Procedures

00190

CPT 00190: Anesthesia for Facial Bones or Skull Procedures

00215

CPT 00215: Anesthesia for Extradural Intracranial Procedures

00216

CPT 00216: Anesthesia for Intracranial Percutaneous Vascular Procedures

00170

CPT 00170: Anesthesia for Intraoral Procedures, Including Biopsy

00322

CPT 00322: Anesthesia for Neck Procedures Including Thyroid Biopsy

00124

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

00142

CPT 00142: Anesthesia for Eye Lens Surgery

00350

CPT 00350: Anesthesia for Major Vessels of the Neck

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