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.
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
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Modifiers:
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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.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology 367500000XCertified Registered Nurse Anesthetist (CRNA) 207RA0401XAnesthesiology Assistant
Related Diagnoses
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K35.80- Acute appendicitis without perforation or gangrene- Relevant for patients undergoing laparoscopic appendectomy, requiring anesthesia for intraperitoneal procedures.
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K40.90- Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent- Relevant for patients undergoing laparoscopic repair of inguinal hernia, necessitating anesthesia.
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K56.60- Unspecified intestinal obstruction- Relevant for patients needing surgical intervention for intestinal obstruction, requiring anesthesia for intraperitoneal procedures.
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K57.30- Diverticulosis of large intestine without perforation or abscess without bleeding- Relevant for patients undergoing procedures such as colectomy or enterolysis, requiring anesthesia.
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K63.5- Polyp of colon- Relevant for patients undergoing surgical removal of colon polyps, necessitating anesthesia for intraperitoneal procedures.
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.
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: AK1 / 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.
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.