CPT 00542: Anesthesia for Removal of Lung Lining - OpenPayer

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Summary & Overview

CPT 00542: Anesthesia for Removal of Lung Lining

CPT code 00542 covers anesthesia services for the removal of the lung lining, a critical component of intrathoracic surgical procedures. This code is nationally recognized for its role in ensuring proper billing and documentation of anesthesia care during complex thoracic operations. The procedure is most commonly performed in hospital inpatient settings, reflecting its clinical complexity and the need for specialized anesthesiology expertise.

Major payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Understanding coverage and reimbursement policies for CPT code 00542 is vital for hospitals, anesthesiology groups, and billing professionals seeking to navigate payer requirements and optimize compliance.

Readers will gain insight into the clinical context of anesthesia for lung lining removal, relevant benchmarks, and recent policy updates affecting this code. The publication also highlights associated modifiers, taxonomies, and related CPT codes, providing a comprehensive overview for stakeholders involved in anesthesia billing and compliance. This summary serves as a resource for understanding national trends and payer coverage for CPT code 00542.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00542anesthesiaintrathoracic procedureshospital inpatientlung lining removalmedical billingpolicy updatesclinical benchmarkssurgical anesthesiacompliance

CPT Code Overview

CPT code 00542 is designated for anesthesia services provided during the removal of the lung lining, a procedure typically performed as part of intrathoracic surgical interventions. This code is used to report anesthesia care for patients undergoing complex thoracic operations, specifically targeting the pleura or other lung linings. The service type is Anesthesia – Intrathoracic Procedures, and the typical site of service is a hospital inpatient setting, such as an operating room. This code is essential for accurately documenting and billing anesthesia services associated with these specialized thoracic surgeries.

Clinical & Coding Specifications

Clinical Context

A patient is admitted to the hospital for surgical removal of the lung lining, typically due to conditions such as congenital heart defects or pulmonary complications. The procedure is performed in an inpatient operating room setting. An anesthesiologist or pediatric anesthesiologist provides anesthesia care throughout the intrathoracic procedure, ensuring patient safety and comfort. The clinical workflow involves preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative recovery. This scenario is common in pediatric patients with complex cardiac or pulmonary diagnoses requiring surgical intervention.

Coding Specifications

Modifiers:
- Modifier QS: Indicates that monitored anesthesia care service was provided during the procedure.
- Modifier P1: Used when the patient is a normal healthy individual undergoing anesthesia.
Provider Taxonomies:

Taxonomy Code Specialty Name

National Reimbursement Benchmarks

National mean rates for CPT code 00542 show that commercial payers such as Blue Cross Blue Shield, Cigna, and Aetna reimburse at significantly higher levels than UnitedHealth Group. The average commercial benchmark (BUCA) is $329.92, while UnitedHealth Group's mean rate is $65.54. Medicare data is not available in the input, so no comparison can be made.

Rate dispersion varies widely across payers. UnitedHealth Group has the tightest range, with a difference of $25.47 between the 75th and 25th percentiles, indicating relatively consistent rates. In contrast, Cigna exhibits the widest dispersion, with a $1,208.50 gap between the 75th and 25th percentiles, reflecting substantial variability in contracted rates. Blue Cross Blue Shield and Aetna also show broad ranges, while BUCA's dispersion is moderate.

The table and chart below present the full breakdown of national benchmarks for each payer.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska exhibits a wide range in reimbursement rates for CPT code 00542, with Blue Cross Blue Shield showing the largest spread between the 25th and 75th percentiles ($1,107.00 minus $761.60 = $345.40). In contrast, Aetna, Cigna, and UnitedHealth Group have much narrower spreads, with their rates clustered closely around the lower percentiles. This indicates that Blue Cross Blue Shield's rates are not only the highest but also the most variable among the major payers in Alaska.

When compared to national averages, Blue Cross Blue Shield and Aetna pay significantly more in Alaska, while Cigna and UnitedHealth Group reimburse at lower rates than their national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these differences and the overall distribution across the state.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 00542, with a mean rate of $941.94, while UnitedHealth Group is the lowest at $75.12.
The rate spread is substantial, especially for Blue Cross Blue Shield, with a 75th percentile of $1,107 and a 25th percentile of $761.60, indicating significant variability.
Compared to national averages, Aetna and Blue Cross Blue Shield pay notably higher mean rates in Alaska, while Cigna and UnitedHealth Group pay lower than their national benchmarks.

Related Codes

00520

CPT 00520: Anesthesia for Closed Chest Procedures Including Bronchoscopy

00541

CPT 00541: Anesthesia for Thoracotomy with One Lung Ventilation

00567

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

00406

CPT 00406: Anesthesia for Breast Surgery

00600

CPT 00600: Anesthesia for Spine and Spinal Cord Procedures

00529

CPT 00529: Anesthesia for Closed Chest Procedures with One Lung Ventilation

00566

CPT 00566: Anesthesia for Direct CABG Without Pump Oxygenator

00626

CPT 00626: Anesthesia for Thoracic Spine Surgery with One-Lung Ventilation

00540

CPT 00540: Anesthesia for Chest Surgery

00632

CPT 00632: Anesthesia for Lumbar Region Procedures Including Sympathectomy

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Related CPT Codes

CPT Code	Description	Clinical Relationship
`00540`	ANESTHESIA THORACOTOMY PROCEDURES NOS	Used for anesthesia during unspecified thoracotomy procedures; may be an alternative to `00542` depending on the surgical approach.
`00541`	ANESTHESIA THORACOTOMY PX W/1 LUNG VNTJ	Used when thoracotomy procedures require ventilation of only one lung; can be used in similar clinical scenarios as `00542`.
`00546`	ANES THORACOTOMY PX PULMONARY RESCJ W/THORACOP	Used for anesthesia during thoracotomy procedures involving pulmonary resection; may be used together with or as an alternative to `00542`.
`00548`	ANES THORACOTOMY PX NTRATHRC PX TRACHEA&BRONCHI	Used for anesthesia during intrathoracic procedures involving the trachea and bronchi; related to `00542` when airway structures are involved.

These codes are commonly used as alternatives or in conjunction with 00542 depending on the specific surgical procedure performed.