Summary & Overview
CPT 00539: Anesthesia for Thoracotomy with Cardiopulmonary Bypass
CPT code 00539 represents anesthesia for thoracotomy procedures involving the lungs, pleura, diaphragm, and mediastinum, specifically when cardiopulmonary bypass is utilized. This code is significant nationally due to its application in high-acuity surgical cases that require advanced anesthesiology expertise. The procedures covered by this code are typically performed in inpatient hospital settings and are associated with critical interventions for conditions such as pulmonary disorders, pleural effusions, and cardiac valve issues.
Major commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for services billed under CPT code 00539. The publication offers insights into payer coverage, clinical benchmarks, and policy updates relevant to this anesthesia service. Readers will gain an understanding of the clinical context for the code, typical sites of service, and its role in supporting complex thoracic and cardiac surgeries. The summary also highlights related codes and modifiers commonly used in conjunction with 00539, providing a comprehensive overview for stakeholders in anesthesiology and hospital billing.
CPT Code Overview
CPT code 00539 is used to report anesthesia services for thoracotomy procedures involving the lungs, pleura, diaphragm, and mediastinum when cardiopulmonary bypass is required. This code falls under the anesthesiology service type and is typically performed in an inpatient hospital setting (Place of Service 21). These procedures are complex and require specialized anesthesia care due to the involvement of major thoracic structures and the use of cardiopulmonary bypass.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient admitted to an inpatient hospital for a thoracotomy procedure due to a complex pulmonary or cardiac condition. The patient may present with pleural effusion, pneumothorax, pulmonary hypertension, or mitral valve insufficiency, requiring surgical intervention involving the lungs, pleura, diaphragm, or mediastinum. The procedure necessitates the use of cardiopulmonary bypass, and anesthesia is provided by an anesthesiologist or a certified registered nurse anesthetist (CRNA) under medical direction. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care in a critical care setting.
Coding Specifications
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Modifiers:
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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.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology 207LC0200XCritical Care Medicine (Anesthesiology) 207LC0201XPain Medicine (Anesthesiology)
These taxonomies represent providers specializing in anesthesia, critical care, and pain medicine within the field of anesthesiology.
Related Diagnoses
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J98.4- Other disorders of lung- Relevant for patients undergoing thoracotomy due to complex lung disorders requiring surgical intervention.
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J94.9- Pleural effusion, not elsewhere classified- Indicates accumulation of fluid in the pleural space, often necessitating thoracotomy procedures.
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J93.9- Pneumothorax, unspecified- Represents air in the pleural space, which may require surgical management via thoracotomy.
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I27.2- Other secondary pulmonary hypertension- Pulmonary hypertension can complicate thoracic surgery and may require cardiopulmonary bypass during the procedure.
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I34.0- Nonrheumatic mitral (valve) insufficiency- Mitral valve insufficiency may necessitate surgical repair or replacement, often performed with cardiopulmonary bypass and anesthesia as described by CPT code
00539.
- Mitral valve insufficiency may necessitate surgical repair or replacement, often performed with cardiopulmonary bypass and anesthesia as described by CPT code
Related CPT Codes
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32480- Removal of lung, pneumonectomy- This code represents a surgical procedure to remove an entire lung. It is clinically related as anesthesia for this procedure may require cardiopulmonary bypass, aligning with CPT code
00539.
- This code represents a surgical procedure to remove an entire lung. It is clinically related as anesthesia for this procedure may require cardiopulmonary bypass, aligning with CPT code
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32663- Thoracoscopy, surgical; with lobectomy- This code involves minimally invasive surgical removal of a lung lobe. Anesthesia for this procedure may also involve cardiopulmonary bypass, making it relevant to CPT code
00539.
- This code involves minimally invasive surgical removal of a lung lobe. Anesthesia for this procedure may also involve cardiopulmonary bypass, making it relevant to CPT code
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33405- Replacement, mitral valve, with cardiopulmonary bypass- This code is for mitral valve replacement surgery requiring cardiopulmonary bypass. Anesthesia for this procedure is directly related to CPT code
00539.
- This code is for mitral valve replacement surgery requiring cardiopulmonary bypass. Anesthesia for this procedure is directly related to CPT code
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33533- Coronary artery bypass, using arterial graft(s)- This code covers coronary artery bypass surgery with arterial grafts. Anesthesia for this procedure may involve cardiopulmonary bypass, and is commonly coded with CPT code
00539.
- This code covers coronary artery bypass surgery with arterial grafts. Anesthesia for this procedure may involve cardiopulmonary bypass, and is commonly coded with CPT code
These codes are often used together or as alternatives depending on the specific surgical intervention and whether cardiopulmonary bypass is required.
National Reimbursement Benchmarks
National mean rates for CPT code 00539 show significant variation across commercial payers. The average commercial rate (BUCA) is $596.74, while UnitedHealth Group is notably lower at $80.16. Blue Cross Blue Shield and Cigna have the highest mean rates, at $938.22 and $959.85 respectively. No Medicare data is available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Cigna ($1,467.67) and BUCA ($994.33), indicating substantial variability in contracted rates. Blue Cross Blue Shield also shows a wide range ($618.33), while UnitedHealth Group has the tightest spread ($49.00), suggesting more consistent rates across providers.
The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska displays a wide range in reimbursement rates for CPT code 00539, with Blue Cross Blue Shield offering the highest mean rate at $1,213.15 and UnitedHealth Group the lowest at $69.87. The rate spread is particularly notable for Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $703.40, indicating substantial variability in payments. In contrast, Aetna, Cigna, and UnitedHealth Group show much narrower spreads, with Aetna's rates fixed at $72.00 across all percentiles.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably higher, while Cigna and UnitedHealth Group are below their respective national means. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting these disparities and the overall landscape for CPT code 00539 reimbursement.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 00539, with a mean rate of $1,213.15.
- UnitedHealth Group offers the lowest mean rate at $69.87.
- Alaska's mean rates for most payers, especially Blue Cross Blue Shield and BUCA, are significantly higher than national averages, while Cigna and UnitedHealth Group are notably lower.
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.