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

Beta

OpenPayer Beta

Summary & Overview

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

CPT code 00474 represents anesthesia services for procedures on the thorax, including the chest wall and shoulder girdle, when no more specific code applies. This code is significant for hospitals and anesthesia providers nationwide, as it ensures proper billing and documentation for a variety of thoracic procedures that require anesthesia but are not otherwise classified. The code is most frequently used in inpatient hospital settings, reflecting its role in complex surgical cases.

Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare recognize and reimburse for CPT code 00474, making it a key component in anesthesiology billing practices. Readers will gain insights into payer coverage, typical clinical scenarios, and relevant policy updates associated with this code. The publication also provides context on related codes, common modifiers, and associated clinical diagnoses, offering a comprehensive overview for stakeholders in hospital billing, compliance, and clinical operations.

This summary serves as a resource for understanding the clinical and administrative importance of CPT code 00474, including its role in anesthesia for thoracic procedures, payer coverage, and its place within the broader landscape of anesthesiology coding.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00474anesthesiologyinpatient hospitalthoracic procedureschest wallshoulder girdlemedical billingpolicy updateclinical codingprocedure documentation

CPT Code Overview

CPT code 00474 is used to report anesthesia services for procedures performed on the thorax, specifically the chest wall and shoulder girdle, when not otherwise specified. This code falls under the anesthesiology service type and is most commonly utilized in the inpatient hospital setting (Place of Service 21). The code is essential for accurately documenting and billing anesthesia care provided during a range of thoracic procedures that do not fit into more specific anesthesia codes.

Clinical & Coding Specifications

Clinical Context

A patient is admitted to an inpatient hospital for a procedure involving the thorax, specifically the chest wall or shoulder girdle, that is not otherwise specified. The patient may present with conditions such as pleural effusion, rib fracture, clavicle fracture, lung disorders, or a malignant neoplasm of the bronchus or lung. An anesthesiology provider, such as a physician anesthesiologist or a Certified Registered Nurse Anesthetist (CRNA), administers anesthesia to facilitate the surgical or diagnostic procedure. The clinical workflow includes preoperative assessment, anesthesia induction, intraoperative monitoring, and postoperative care, with documentation of anesthesia time and relevant modifiers as appropriate.

Coding Specifications

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 anesthesiologist.
Provider Taxonomies:

Taxonomy Code	Specialty Description

National Reimbursement Benchmarks

For CPT code 00474, national mean rates among commercial payers (BUCA average) are $263.52, which are substantially higher than the typical Medicare rates, though Medicare data is not available in the input for direct comparison. Among individual commercial payers, Cigna and Blue Cross Blue Shield report the highest mean rates at $698.32 and $628.13, respectively, while UnitedHealth Group is notably lower at $65.62.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. UnitedHealth Group has the tightest range ($25.67), indicating less variability in reimbursement, while Cigna shows the widest spread ($1,026.00), reflecting substantial rate variation. Blue Cross Blue Shield and Aetna also exhibit considerable dispersion, with ranges of $419.20 and $689.00, respectively.

The table and chart below present a detailed breakdown of national benchmarks for CPT code 00474 by payer, including mean rates and percentile values.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska demonstrates a substantial spread in reimbursement rates for CPT code 00474, particularly among commercial payers. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($295.33) and BUCA ($445.93), indicating significant variability in negotiated rates. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal spread, with nearly flat rates across percentiles, suggesting standardized contracts or limited negotiation.

Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably higher, while UnitedHealth Group and Cigna remain below or near national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting the diversity in reimbursement across the market.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00474 in Alaska, with a mean rate of $819.25.
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

00670

CPT 00670: Anesthesia for Extensive Spine and Spinal Cord Procedures

00530

CPT 00530: Anesthesia for Cardiac Procedures with Pump Oxygenator

00546

CPT 00546: Anesthesia for Intrathoracic Procedures

00600

CPT 00600: Anesthesia for Spine and Spinal Cord Procedures

00500

CPT 00500: Anesthesia for Procedures on the Esophagus

00580

CPT 00580: Anesthesia for Heart and Lung Transplant

00542

CPT 00542: Anesthesia for Removal of Lung Lining

00541

CPT 00541: Anesthesia for Thoracotomy with One Lung Ventilation

00522

CPT 00522: Anesthesia for Needle Biopsy of Pleura, Closed Chest Procedure

00524

CPT 00524: Anesthesia for Closed Drainage of Lung Fluid

Showing 1–10 of 42

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.

Free Report

See how your rates compare to the market.

Get a free custom competitive market analysis.