CPT 00790 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 00790: Anesthesia for Upper Abdominal Intraperitoneal Procedures

CPT code 00790 covers anesthesia for intraperitoneal procedures in the upper abdomen, including laparoscopy, when not otherwise specified. This code is significant for hospitals and surgical teams nationwide, as it applies to a broad spectrum of abdominal surgeries requiring specialized anesthesia care. The code is most frequently used in inpatient hospital settings, reflecting its role in major surgical interventions.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Understanding how these payers approach coverage and reimbursement for CPT 00790 is essential for providers, billing teams, and policy analysts seeking to navigate the complexities of anesthesiology billing.

Readers will gain insight into national benchmarks, payer policy updates, and the clinical context surrounding the use of CPT 00790. The publication also highlights relevant modifiers, associated provider taxonomies, and common clinical diagnoses linked to this code. By examining these elements, stakeholders can better understand the operational and policy landscape for anesthesia services in upper abdominal procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00790anesthesiologyinpatient hospitalintraperitoneal procedureslaparoscopymedical billingclinical contextpolicy updatesbenchmarksupper abdomen surgery

CPT Code Overview

CPT 00790 is used to report anesthesia services for intraperitoneal procedures in the upper abdomen, including laparoscopy, when not otherwise specified. This code falls under the anesthesiology service type and is most commonly performed in an inpatient hospital setting (POS 21). It is utilized for a range of surgical interventions requiring anesthesia in the upper abdominal region, ensuring patient comfort and safety during complex procedures.

Clinical & Coding Specifications

Clinical Context

A patient is admitted to an inpatient hospital for a surgical procedure involving the upper abdomen, such as a laparoscopic cholecystectomy, appendectomy, or repair of an inguinal hernia. The patient may present with conditions like acute appendicitis, intestinal obstruction, or diverticulosis. An anesthesiology provider, such as an anesthesiologist, certified registered nurse anesthetist (CRNA), or anesthesiology assistant, administers anesthesia for the intraperitoneal procedure. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia during the surgery, and postoperative monitoring in the recovery area.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider is present and monitoring the patient, but not providing general anesthesia.
- QX: CRNA service with medical direction by a physician. Used when a CRNA is providing anesthesia care under the medical direction of a physician.
Provider Taxonomies:

Taxonomy Code Specialty Name

National Reimbursement Benchmarks

National mean rates for CPT code 00790 show significant variation among commercial payers. The average commercial rate (BUCA) is $263.44, while UnitedHealth Group is notably lower at $65.62. Blue Cross Blue Shield and Cigna are both above $370, with Aetna leading at $542.41. Medicare rates are not available in the input.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Aetna ($748.50) and Cigna ($519.50), indicating greater variability in contracted rates. UnitedHealth Group has the tightest range ($25.38), suggesting more consistent reimbursement levels. Blue Cross Blue Shield and BUCA show moderate dispersion.

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 spread in reimbursement rates for CPT code 00790, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($233.87), while UnitedHealth Group and Aetna have much narrower spreads ($4.00 and $30.00, respectively). This indicates significant variability in payment levels depending on the payer, with Blue Cross Blue Shield offering both higher average rates and greater rate dispersion compared to other payers in the state.

Compared to national averages, Blue Cross Blue Shield's mean rate in Alaska is substantially higher, while Cigna and UnitedHealth Group are well below their national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these differences and the overall landscape for CPT code 00790 in the state.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00790 in Alaska, with a mean rate of $483.89.
UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both state and national averages.
Cigna and UnitedHealth Group's rates in Alaska are notably lower than their respective national mean rates, while Blue Cross Blue Shield's mean rate is substantially higher than its national average.

CPT 00770: Anesthesia for Major Abdominal Vascular Procedures

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

CPT 00797: Anesthesia for Upper Abdominal Intraperitoneal Procedures

00756-UNDER-ANESTHESIA-FOR-PROCEDURES-ON-THE-UPPER

CPT 00756: Anesthesia for Procedures on the Upper Abdomen

00752-ANESTHESIA-FOR-HERNIA-REPAIRS-IN-UPPER-ABDOMEN-LUMBAR-AND

CPT 00752: Anesthesia for Upper Abdominal Hernia Repairs

CPT-00731-UPPER-GI-ENDOSCOPY-ANESTHESIA

CPT 00731: Anesthesia for Upper Gastrointestinal Endoscopy, Proximal Duodenum

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

CPT 00792: Anesthesia for Partial Hepatectomy or Liver Hemorrhage Procedures

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

CPT 00754: Anesthesia for Shoulder and Axilla Procedures

00730-ANESTHESIA-FOR-PROCEDURES-ON-UPPER-POSTERIOR-ABDOMINAL

CPT 00730: Anesthesia for Upper Posterior Abdominal Wall Procedures

00702-ANESTHESIA-FOR-PROCEDURES-ON-THE-UPPER-ANTERIOR-ABDOMINAL

CPT 00702: Anesthesia for Upper Anterior Abdominal Wall Procedures

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

CPT 00700: Anesthesia for Upper Anterior Abdominal Wall Procedures

Showing 1–10 of 14

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.

Related CPT Codes

CPT Code	Description	Clinical Relationship to `00790`
`47562`	Laparoscopy, surgical; cholecystectomy	Anesthesia for this procedure is coded with `00790`.
`44970`	Laparoscopy, surgical, appendectomy	Anesthesia for this procedure is coded with `00790`.
`49650`	Laparoscopy, surgical; repair initial inguinal hernia	Anesthesia for this procedure is coded with `00790`.
`44180`	Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion)	Anesthesia for this procedure is coded with `00790`.
`44204`	Laparoscopy, surgical; colectomy, partial, with anastomosis	Anesthesia for this procedure is coded with `00790`.

These codes represent the surgical procedures for which anesthesia services described by 00790 are provided. 00790 is commonly used in conjunction with these codes during intraperitoneal upper abdominal surgeries.

OpenPayer

Summary & Overview

CPT 00790: Anesthesia for Upper Abdominal Intraperitoneal 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