CPT 00539 Reimbursement Benchmarks & Policy | OpenPayer

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00539anesthesiologythoracotomycardiopulmonary bypassinpatient hospitalmedical billingclinical benchmarkspolicy updatescritical carepain medicine

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

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.
Provider Taxonomies:

Taxonomy Code Specialty Name

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: Alaska1 / 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.

CPT 00541: Anesthesia for Thoracotomy with One Lung Ventilation

00563-ANESTH-HEART-PROC

CPT 00563: Anesthesia for Heart Procedures with Pump

00532-ANESTHESIA-ACCESS-CENTRAL-VENOUS

CPT 00532: Anesthesia for Central Venous Circulation Access

00540-ANESTHESIA-FOR-CHEST

CPT 00540: Anesthesia for Chest Surgery

CPT-00561-INFANT-CARDIAC-ANESTHESIA-WITH-BYPASS

CPT 00561: Infant Cardiac Anesthesia with Cardiopulmonary Bypass

00500-ANESTHESIA-FOR-PROCEDURES-ON

CPT 00500: Anesthesia for Procedures on the Esophagus

00522-ANESTHESIA-FOR-CLOSED-CHEST-PROCEDURES-NEEDLE-BIOPSY-OF

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

00528-ANESTHESIA-FOR-CLOSED-CHEST-PROCEDURES-MEDIASTINOSCOPY-AND

CPT 00528: Anesthesia for Closed Chest Procedures, Mediastinoscopy/Thoracoscopy

00567-UNDER-ANESTHESIA-FOR-CORONARY-ARTERY-BYPASS-GRAFT-PROCEDURE

CPT 00567: Anesthesia for Coronary Artery Bypass Graft with Pump Oxygenator

00580-ANESTHESIA-FOR-TRANSPLANT-OF-HEART-AND

CPT 00580: Anesthesia for Heart and Lung Transplant

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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.

`207L00000X`	Anesthesiology
`207LC0200X`	Critical Care Medicine (Anesthesiology)
`207LC0201X`	Pain Medicine (Anesthesiology)

OpenPayer

Summary & Overview

CPT 00539: Anesthesia for Thoracotomy with Cardiopulmonary Bypass

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes