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

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Summary & Overview

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

CPT code 00567 covers anesthesia services for coronary artery bypass graft procedures requiring a pump oxygenator, a critical component in advanced cardiac surgery. This code is nationally significant due to the prevalence of coronary artery disease and the frequency of bypass operations in hospital settings. The analysis includes coverage details from major payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer policies and reimbursement benchmarks.

Readers will gain insight into the clinical context of 00567, including its role in supporting patient outcomes during complex cardiac procedures. The publication outlines typical sites of service, relevant modifiers, and associated provider taxonomies, offering clarity on billing and documentation requirements. Additionally, the summary highlights related CPT codes and common ICD-10 diagnoses, equipping stakeholders with the information needed to navigate policy updates and understand national trends in anesthesia billing for cardiac surgery. This resource is designed for healthcare professionals, administrators, and policy analysts seeking up-to-date information on anesthesia coding for coronary artery bypass grafts.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00567anesthesiacoronary artery bypass graftintrathoracic procedureshospital inpatientoperating roomcardiac surgerymedical billingpolicy updateclinical context

CPT Code Overview

CPT code 00567 is used for reporting anesthesia services provided during coronary artery bypass graft procedures that require the use of a pump oxygenator. This code falls under the category of anesthesia for intrathoracic procedures, specifically for complex cardiac surgeries. The typical site of service for this procedure is the hospital inpatient operating room (Place of Service 21), reflecting the high-acuity nature of the intervention. This code is essential for accurately documenting and billing anesthesia care during advanced cardiac operations.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult admitted to the hospital with advanced coronary artery disease, such as atherosclerotic heart disease of the native coronary arteries. The patient is scheduled for a coronary artery bypass graft (CABG) procedure requiring the use of a pump oxygenator. The anesthesia team, which may include an anesthesiology physician or a certified registered nurse anesthetist (CRNA), provides anesthesia services in the operating room during the surgical procedure. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care, all coordinated with the surgical and cardiovascular teams.

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 certified registered nurse anesthetist provides anesthesia services under the medical direction of a physician.
Provider Taxonomies:

Taxonomy Code Specialty Description

National Reimbursement Benchmarks

National mean rates for CPT code 00567 show that BUCA (average commercial) is at $459.85, while UnitedHealth Group is significantly lower at $65.53. Blue Cross Blue Shield, Aetna, and Cigna all report higher mean rates, with Cigna leading at $962.78. The mean rate for BUCA is less than half of Cigna's, highlighting substantial variation among commercial payers.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Aetna ($1,237.87) and Cigna ($1,468.00), indicating broad variability in contracted rates. Blue Cross Blue Shield shows a tighter range ($562.67), while UnitedHealth Group has the narrowest spread ($25.33), suggesting more consistent rates nationally. 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 spread in reimbursement rates for CPT code 00567, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($661.07), while Aetna, Cigna, and UnitedHealth Group display minimal spreads, indicating consistent rates across providers. The mean rates for Blue Cross Blue Shield and BUCA in Alaska are notably higher than their respective national averages, whereas Cigna and UnitedHealth Group are below national benchmarks.

The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting the significant variation in reimbursement across payers for this procedure.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00567 in Alaska, with a mean rate of $1,211.62.
UnitedHealth Group offers the lowest mean rate at $75.12.
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 below national benchmarks.

Related Codes

00635

CPT 00635: Anesthesia for Lumbar Puncture Procedures

00470

CPT 00470: Anesthesia for Partial Rib Resection

00580

CPT 00580: Anesthesia for Heart and Lung Transplant

00640

CPT 00640: Anesthesia for Spine and Spinal Cord Procedures

00542

CPT 00542: Anesthesia for Removal of Lung Lining

00620

CPT 00620: Anesthesia for Thoracic Spine and Cord Procedures

00550

CPT 00550: Anesthesia for Direct Coronary Artery Bypass Grafting, Without Pump Oxygenator

00634

CPT 00634: Anesthesia for Thoracic Spine and Cord Procedures

00400

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

00530

CPT 00530: Anesthesia for Cardiac Procedures with Pump Oxygenator

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