CPT 00635 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 00635: Anesthesia for Lumbar Puncture Procedures

CPT code 00635 covers anesthesia for diagnostic or therapeutic lumbar puncture procedures, a critical service in the management of spinal and neurological conditions. This code is widely used in inpatient hospital settings, reflecting its importance in acute care and complex cases. Nationally, the code is recognized by major commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage for patients requiring lumbar puncture anesthesia.

This publication provides a comprehensive overview of CPT code 00635, including payer coverage, clinical context, and relevant billing modifiers. Readers will gain insight into the typical clinical scenarios where lumbar puncture anesthesia is indicated, such as for patients with intervertebral disc displacement, spinal stenosis, or chronic low back pain. The article also highlights associated taxonomies for anesthesia professionals and outlines related CPT codes for similar spinal procedures. Key policy updates and reimbursement benchmarks are discussed to inform stakeholders about current trends and requirements in medical billing for anesthesia services on the spine and spinal cord.

Healthcare professionals, administrators, and policy analysts will find this summary useful for understanding the national landscape of lumbar puncture anesthesia billing, payer coverage, and clinical indications.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00635anesthesialumbar puncturespine proceduresinpatient hospitalmedical billingclinical contextpolicy updatesreimbursementdiagnostic procedures

CPT Code Overview

CPT code 00635 is used to report anesthesia services for procedures in the lumbar region, specifically for diagnostic or therapeutic lumbar punctures. This code falls under the Anesthesia – Procedures on the Spine and Spinal Cord service type. The typical site of service for procedures billed under CPT code 00635 is the Inpatient Hospital setting (Place of Service 21).

Clinical & Coding Specifications

Clinical Context

A patient is admitted to an inpatient hospital for evaluation and management of lumbar spine-related symptoms, such as chronic low back pain, radiculopathy, or suspected spinal stenosis. The clinical workflow involves a diagnostic or therapeutic lumbar puncture performed in the lumbar region. An anesthesia provider, such as an anesthesiologist, certified registered nurse anesthetist, or anesthesiology assistant, administers anesthesia to ensure patient comfort and safety during the procedure. The anesthesia service is documented and coded using CPT code 00635.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care during the lumbar puncture procedure.
- QX: CRNA service with medical direction by a physician. Used when a certified registered nurse anesthetist provides anesthesia under the medical direction of a physician.
Provider Taxonomies:

Taxonomy Code	Specialty Name

National Reimbursement Benchmarks

National mean rates for CPT code 00635 show that Blue Cross Blue Shield and Cigna have the highest average reimbursement, with Cigna at $248.08 and Blue Cross Blue Shield at $228.86. UnitedHealth Group is notably lower at $65.59, while the average commercial rate (BUCA) stands at $134.52. Medicare rates are not available in the input for comparison.

Rate dispersion varies significantly across payers. Blue Cross Blue Shield has the tightest range between the 25th and 75th percentiles ($123.50), indicating more consistent reimbursement. Aetna and Cigna display much wider ranges ($278.33 and $259.00, respectively), reflecting greater variability in payment amounts. UnitedHealth Group and BUCA have moderate dispersion, with ranges of $25.42 and $149.03.

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

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a wide rate spread for CPT code 00635, particularly with Blue Cross Blue Shield, where the 75th percentile ($300.00) is $74.20 higher than the 25th percentile ($225.80). BUCA also shows a substantial spread of $126.00 between its 75th and 25th percentiles. In contrast, Aetna, Cigna, and UnitedHealth Group have minimal spreads, with all percentiles clustered closely together, indicating less variability in reimbursement rates among these payers.

Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are notably higher, while Cigna and UnitedHealth Group are below their respective national means. The table and chart below present the full breakdown of payer-specific reimbursement benchmarks for Alaska.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 00635, with a mean rate of $268.93.
UnitedHealth Group offers the lowest mean rate at $75.12.
Alaska's mean rates for most payers are higher than national averages, especially for Blue Cross Blue Shield and BUCA.

CPT 00620: Anesthesia for Thoracic Spine and Cord Procedures

00600-ANESTHESIA-FOR-PROCEDURES-ON-THE-SPINE-AND-SPINAL

CPT 00600: Anesthesia for Spine and Spinal Cord Procedures

00640-ANESTHESIA-FOR-PROCEDURES-INVOLVING-THE-SPINE-AND-SPINAL

CPT 00640: Anesthesia for Spine and Spinal Cord Procedures

00630-ANESTHESIA-FOR-PROCEDURES-IN-LUMBAR-REGION-NOT-OTHERWISE

CPT 00630: Anesthesia for Lumbar Procedures, Not Otherwise Specified

00632-ANESTHESIA-FOR-PROCEDURES-IN-LUMBAR-REGION-INCLUDING-LUMBAR

CPT 00632: Anesthesia for Lumbar Region Procedures Including Sympathectomy

00604-ANESTHESIA-FOR-PROCEDURES-ON-CERVICAL-SPINE-AND-CORD

CPT 00604: Anesthesia for Cervical Spine Procedures in Sitting Position

00670-ANESTHESIA-FOR-EXTENSIVE-SPINE-AND-SPINAL-CORD-PROCEDURES

CPT 00670: Anesthesia for Extensive Spine and Spinal Cord Procedures

00625-ANESTHESIA-FOR-PROCEDURES-ON-THE-THORACIC-SPINE-AND-CORD

CPT 00625: Anesthesia for Thoracic Spine Procedures, Anterior Approach

00626-ANESTHESIA-SERVICES-FOR-PROCEDURES-ON-THE-THORACIC-SPINE

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

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
`367500000X`	Certified Registered Nurse Anesthetist
`207RA0401X`	Anesthesiology Assistant

OpenPayer

Summary & Overview

CPT 00635: Anesthesia for Lumbar Puncture Procedures

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