CPT 00730 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 00730: Anesthesia for Upper Posterior Abdominal Wall Procedures

CPT code 00730 covers anesthesia for procedures on the upper posterior abdominal wall, a critical area for various abdominal surgeries. This code is nationally recognized and utilized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. It is most commonly billed in inpatient hospital settings, reflecting the complexity and clinical significance of the procedures involved.

The publication provides a comprehensive overview of 00730, including payer coverage, clinical context, and relevant policy updates. Readers will gain insight into typical use cases, associated diagnoses, and related CPT codes for similar anesthesia services. The analysis also highlights common modifiers used in billing, such as QS for monitored anesthesia care and QX for CRNA services with physician direction. Additionally, the document outlines the professional taxonomies associated with this code, ensuring clarity on who may provide these services.

Healthcare professionals, administrators, and policy analysts will find benchmarks and regulatory considerations relevant to anesthesia billing for upper posterior abdominal wall procedures. The summary equips stakeholders with the information needed to understand national trends, payer requirements, and clinical applications for CPT code 00730.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00730anesthesiaabdominal wall proceduresinpatient hospitalmedical billingclinical codingpolicy updatesbenchmarksmodifier codestaxonomies

CPT Code Overview

CPT code 00730 is designated for anesthesia services provided during procedures on the upper posterior abdominal wall. This code is used to report the administration of anesthesia by qualified professionals for surgical interventions targeting this specific anatomical region. The service type is anesthesia, and the typical site of service is an inpatient hospital setting (POS 21). This code ensures accurate billing and documentation for anesthesia care during complex abdominal procedures requiring hospitalization.

Clinical & Coding Specifications

Clinical Context

A patient is admitted to an inpatient hospital for surgical repair of an upper posterior abdominal wall hernia, such as a ventral, umbilical, or diaphragmatic hernia. The procedure requires general anesthesia, administered by an anesthesiologist, anesthesiologist assistant, or certified registered nurse anesthetist. The clinical workflow involves preoperative assessment, induction and maintenance of anesthesia during the surgical procedure, and postoperative monitoring in the recovery area. The anesthesia service is coded with 00730 for procedures specifically targeting the upper posterior abdominal wall.

Coding Specifications

Modifiers:

Modifier Code	Description	Usage
`QS`	Monitored anesthesia care service	Used when anesthesia is provided as 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 under the medical direction of a physician.

National Reimbursement Benchmarks

National mean rates for CPT code 00730 show that Blue Cross Blue Shield and Cigna have the highest average commercial reimbursement, with mean rates of $272.25 and $299.13, respectively. UnitedHealth Group's mean rate is notably lower at $65.63, while the BUCA (average commercial) mean rate stands at $140.91. Compared to BUCA, Medicare rates are not available in the input for this code.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. UnitedHealth Group exhibits the tightest range ($75.80 - $50.33 = $25.47), indicating less variability in rates. Cigna has the widest dispersion ($433.00 - $89.00 = $344.00), reflecting substantial variation in contracted rates. The table and chart below present the full breakdown of national benchmarks for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a wide rate spread for CPT code 00730, particularly among commercial payers. Blue Cross Blue Shield shows the largest spread, with a 75th percentile rate of $371.50 and a 25th percentile rate of $274.60, resulting in a $96.90 difference. BUCA also demonstrates a substantial spread of $158.50 between its 75th and 25th percentiles. In contrast, Aetna and UnitedHealth Group have minimal spreads, with all percentiles clustered closely around $72.00, indicating little variation in reimbursement.

Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are notably higher, while UnitedHealth Group and Cigna are closer to or slightly above national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska for CPT code 00730.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 00730, with a mean rate of $330.34.
UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
Alaska's mean rates for most payers are higher than national benchmarks, especially for Blue Cross Blue Shield and BUCA.

CPT 00756: Anesthesia for Procedures on the Upper Abdomen

CPT-00732-ERCP-ANESTHESIA-PROXIMAL-DUODENUM

CPT 00732: Anesthesia for ERCP to Proximal Duodenum

00797-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-UPPER-ABDOMEN

CPT 00797: Anesthesia for Upper Abdominal Intraperitoneal Procedures

00792-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-UPPER-ABDOMEN

CPT 00792: Anesthesia for Partial Hepatectomy or Liver Hemorrhage Procedures

00700-ANESTHESIA-FOR-PROCEDURES-ON-UPPER-ANTERIOR-ABDOMINAL

CPT 00700: Anesthesia for Upper Anterior Abdominal Wall Procedures

00754-ANESTHESIA-FOR-PROCEDURES-ON-THE-SHOULDER-AND-AXILLA-NOT

CPT 00754: Anesthesia for Shoulder and Axilla Procedures

00770-ANESTHESIA-FOR-PROCEDURES-ON-THE-MAJOR-ABDOMINAL-BLOOD

CPT 00770: Anesthesia for Major Abdominal Vascular Procedures

00796-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-UPPER-ABDOMEN

CPT 00796: Anesthesia for Liver Transplant (Recipient)

CPT-00731-UPPER-GI-ENDOSCOPY-ANESTHESIA

CPT 00731: Anesthesia for Upper Gastrointestinal Endoscopy, Proximal Duodenum

00750-ANESTHESIA-FOR-HERNIA-REPAIRS-IN-UPPER-ABDOMEN-NOT

CPT 00750: Anesthesia for Upper Abdominal Hernia Repair

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Summary & Overview

CPT 00730: Anesthesia for Upper Posterior Abdominal Wall 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