Summary & Overview

CPT 00406: Anesthesia for Breast Surgery

CPT code 00406 covers anesthesia services for breast surgery, a procedure commonly performed in inpatient hospital settings across the United States. This code is essential for accurately reporting and reimbursing anesthesia care during breast operations, which may include a range of surgical interventions from biopsies to mastectomies. The code is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage and consistency in billing practices.

This publication provides a comprehensive overview of CPT code 00406, including payer coverage, clinical context, and relevant benchmarks. Readers will gain insight into the typical site of service, associated service types, and the importance of proper coding for anesthesia in breast surgery. The article also highlights policy updates and trends relevant to anesthesia billing, offering clarity for stakeholders navigating the evolving landscape of medical reimbursement. By understanding the scope and application of CPT code 00406, healthcare professionals and administrators can better align clinical documentation and billing processes with national standards.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00406anesthesiabreast surgeryinpatient hospitalmedical billingclinical codingsurgical servicespolicy updatebenchmarking

CPT Code Overview

CPT code 00406 is designated for anesthesia services provided during surgery of the breast. This code is used to report the administration of anesthesia for procedures involving breast surgery, ensuring patient comfort and safety throughout the operative process. The typical site of service for CPT code 00406 is an inpatient hospital setting, specifically place of service 21. As an anesthesia service, it is a critical component of surgical care, supporting both clinical outcomes and operational workflows in hospital environments.

Clinical & Coding Specifications

Clinical Context

A patient is admitted to an inpatient hospital for surgery involving the breast, such as a mastectomy or lumpectomy. The patient may have a diagnosis like malignant neoplasm of the glottis (C32.0), paralysis of vocal cords and larynx (J38.00), tracheostomy complication (J95.02), congenital laryngomalacia (Q31.5), or abnormal sputum (R09.3). An anesthesiologist or certified registered nurse anesthetist (CRNA) provides anesthesia services for the breast surgery. The clinical workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative care. The anesthesia service is documented and coded using CPT code 00406.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider is present and monitoring the patient, but not providing general anesthesia.
- QX: CRNA service with medical direction by a physician. Used when a CRNA is performing the anesthesia service under the medical direction of an anesthesiologist.
Provider Taxonomies:

Taxonomy Code	Specialty Name
`207L00000X`	Anesthesiology
`367500000X`	Certified Registered Nurse Anesthetist
`207LA0401X`	Pain Medicine (Anesthesiology)

Specialties Represented:
- Anesthesiology: Physicians specializing in anesthesia care.
- Certified Registered Nurse Anesthetist: Advanced practice nurses providing anesthesia services.
- Pain Medicine (Anesthesiology): Physicians with additional expertise in pain management within anesthesiology.

Related Diagnoses

C32.0 - Malignant neoplasm of glottis
- Relevant for patients with cancer affecting the glottis, which may require breast surgery as part of a broader oncologic treatment plan.
J38.00 - Paralysis of vocal cords and larynx, unspecified
- Indicates airway or vocal cord dysfunction, which can impact anesthesia management during breast surgery.
J95.02 - Tracheostomy complication
- Patients with tracheostomy complications may require special anesthesia considerations during breast surgery.
Q31.5 - Congenital laryngomalacia
- Congenital airway abnormality that may affect anesthesia approach for breast surgery.
R09.3 - Abnormal sputum
- Indicates respiratory issues that may influence perioperative anesthesia care for breast surgery.

Related CPT Codes

CPT Code	Description	Clinical Relationship
`31500`	Intubation, endotracheal, emergency procedure	May be performed if airway management is required during breast surgery anesthesia.
`31575`	Laryngoscopy, flexible; diagnostic	Used for airway evaluation before or after anesthesia, especially in patients with laryngeal pathology.
`31600`	Tracheostomy, planned (separate procedure)	May be necessary for airway access in complex cases or patients with tracheostomy complications.
`60240`	Thyroidectomy, total or complete	Sometimes performed in the same surgical session or as an alternative procedure requiring anesthesia.

These codes may be used together in complex surgical cases or as alternatives depending on the patient's clinical needs and surgical plan.

Summary & Overview

CPT 00406: Anesthesia for Breast Surgery

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00406anesthesiabreast surgeryinpatient hospitalmedical billingclinical codingsurgical servicespolicy updatebenchmarking

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider is present and monitoring the patient, but not providing general anesthesia.
- QX: CRNA service with medical direction by a physician. Used when a CRNA is performing the anesthesia service under the medical direction of an anesthesiologist.
Provider Taxonomies:

Taxonomy Code	Specialty Name
`207L00000X`	Anesthesiology
`367500000X`	Certified Registered Nurse Anesthetist
`207LA0401X`	Pain Medicine (Anesthesiology)

Specialties Represented:
- Anesthesiology: Physicians specializing in anesthesia care.
- Certified Registered Nurse Anesthetist: Advanced practice nurses providing anesthesia services.
- Pain Medicine (Anesthesiology): Physicians with additional expertise in pain management within anesthesiology.

Related Diagnoses

C32.0 - Malignant neoplasm of glottis
- Relevant for patients with cancer affecting the glottis, which may require breast surgery as part of a broader oncologic treatment plan.
J38.00 - Paralysis of vocal cords and larynx, unspecified
- Indicates airway or vocal cord dysfunction, which can impact anesthesia management during breast surgery.
J95.02 - Tracheostomy complication
- Patients with tracheostomy complications may require special anesthesia considerations during breast surgery.
Q31.5 - Congenital laryngomalacia
- Congenital airway abnormality that may affect anesthesia approach for breast surgery.
R09.3 - Abnormal sputum
- Indicates respiratory issues that may influence perioperative anesthesia care for breast surgery.

Related CPT Codes

CPT Code	Description	Clinical Relationship
`31500`	Intubation, endotracheal, emergency procedure	May be performed if airway management is required during breast surgery anesthesia.
`31575`	Laryngoscopy, flexible; diagnostic	Used for airway evaluation before or after anesthesia, especially in patients with laryngeal pathology.
`31600`	Tracheostomy, planned (separate procedure)	May be necessary for airway access in complex cases or patients with tracheostomy complications.
`60240`	Thyroidectomy, total or complete	Sometimes performed in the same surgical session or as an alternative procedure requiring anesthesia.

These codes may be used together in complex surgical cases or as alternatives depending on the patient's clinical needs and surgical plan.

National Reimbursement Benchmarks

Nationally, the mean rate for BUCA (average commercial) is $274.16, which is substantially higher than the UnitedHealth Group mean rate of $65.57. Among commercial payers, Cigna and Blue Cross Blue Shield have the highest mean rates at $698.31 and $658.25, respectively, while Aetna and BUCA are lower.

Rate dispersion varies significantly across payers. Cigna exhibits the widest spread, with a difference of $1,026.00 between its 75th and 25th percentiles, indicating substantial variability in contracted rates. In contrast, UnitedHealth Group has the tightest range, with only $25.00 separating its 75th and 25th percentiles, suggesting more consistent reimbursement levels.

The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska displays a wide rate spread for CPT code 00406, particularly among Blue Cross Blue Shield, which has a 75th percentile rate of $965.50 and a 25th percentile rate of $664.20, resulting in a spread of $301.30. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal rate variation, with their 25th and 75th percentiles differing by only a few dollars. This indicates that reimbursement rates in Alaska are highly payer-dependent, with some payers offering much more consistent rates than others.

Compared to national averages, Blue Cross Blue Shield and BUCA in Alaska pay substantially more, while Cigna and UnitedHealth Group rates are notably lower than their national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these disparities.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00406 in Alaska, with a mean rate of $820.06.
UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both state and national averages.
The mean rate for Cigna in Alaska ($89.33) is much lower than its national mean ($698.31), indicating a substantial deviation.

CPT 00402: Anesthesia for Neck, Esophagus, and Airway Procedures

00450-ANESTHESIA-FOR-PROCEDURES-ON-CLAVICLE-AND

CPT 00450: Anesthesia for Clavicle and Scapula Procedures

00404-ANESTHESIA-FOR-PROCEDURES-ON-THE-INTEGUMENTARY-SYSTEM-ON

CPT 00404: Anesthesia for Radical Breast and Integumentary Procedures

00454-ANESTHESIA-FOR-PROCEDURES-ON-CLAVICLE-AND

CPT 00454: Anesthesia for Clavicle and Scapula Procedures

00410-ANESTHESIA-FOR-PROCEDURE-TO-CORRECT-ABNORMAL-HEART

CPT 00410: Anesthesia for Procedure to Correct Abnormal Heart Rhythm

00472-ANESTHESIA-FOR-PARTIAL-RIB

CPT 00472: Anesthesia for Partial Rib Resection

00474-ANESTHESIA-FOR-PROCEDURES-ON-THE-THORAX-CHEST-WALL-AND

CPT 00474: Anesthesia for Thoracic Procedures, Chest Wall and Shoulder Girdle

00400-ANESTHESIA-FOR-PROCEDURES-ON-THE-INTEGUMENTARY-SYSTEM-ON

CPT 00400: Anesthesia for Skin and Soft Tissue Procedures on Extremities and Trunk

00470-ANESTHESIA-FOR-PARTIAL-RIB

CPT 00470: Anesthesia for Partial Rib Resection

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.

OpenPayer

Summary & Overview

CPT 00406: Anesthesia for Breast Surgery

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

OpenPayer

Summary & Overview

CPT 00406: Anesthesia for Breast Surgery

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes