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Summary & Overview

CPT 00834: Anesthesia for Pediatric Lower Abdominal Hernia Repair

CPT code 00834 covers anesthesia for lower abdominal hernia repairs in patients younger than 1 year of age, a procedure that requires specialized care due to the age and clinical complexity of the patient. This code is nationally recognized and is relevant for providers, payers, and policy analysts tracking pediatric surgical anesthesia services. The publication examines coverage and policy benchmarks from major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer practices for this code.

Readers will gain insight into the clinical context of pediatric hernia repair anesthesia, typical sites of service, and the importance of accurate coding for reimbursement and compliance. The summary also highlights related codes and modifiers, offering clarity on distinctions between similar anesthesia services. Policy updates and payer-specific nuances are addressed, equipping stakeholders with the information needed to understand national trends and requirements for anesthesia billing in pediatric hernia repair cases.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00834anesthesiahernia repairpediatric surgeryoutpatient hospitalmedical billingpolicy updateclinical codingbenchmarkingcompliance

CPT Code Overview

CPT code 00834 is used to report anesthesia services for hernia repairs in the lower abdomen that are not otherwise specified, specifically for patients younger than 1 year of age. This code applies to procedures performed in an outpatient hospital setting, classified as Place of Service 22. The service type is anesthesia, which is critical for ensuring patient comfort and safety during surgical interventions in this vulnerable pediatric population.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an infant younger than 1 year of age presenting to an outpatient hospital setting for surgical repair of a hernia located in the lower abdomen. The hernia may be inguinal, femoral, umbilical, ventral, or diaphragmatic, and is not specified as recurrent, obstructed, or gangrenous. The anesthesiology team, often including pediatric anesthesiologists, provides anesthesia services tailored to the unique needs and risks of infants during the hernia repair procedure. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care in the outpatient setting.

Coding Specifications

Modifier 99100: Indicates anesthesia for patients of extreme age (younger than 1 year or older than 70). According to guidelines, do not report modifier 99100 with CPT code 00834 as a qualifier.

Modifier Code	Description	Usage Guidance
`99100`	Anesthesia for patient of extreme age, younger than 1 year and older than 70	Not reported with `00834`

Provider Taxonomies:

Taxonomy Code	Specialty
`207L00000X`	Anesthesiology
`207LA0401X`	Pain Medicine (Anesthesiology)
`207LP2900X`	Pediatric Anesthesiology

These taxonomies represent providers specializing in anesthesia, pain medicine, and pediatric anesthesia, all relevant for the procedure described by CPT code 00834.

Related Diagnoses

K40.90: Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent
- Relevant for infants undergoing anesthesia for inguinal hernia repair.
K41.90: Unilateral femoral hernia, without obstruction or gangrene, not specified as recurrent
- Indicates femoral hernia repair, applicable for anesthesia services in infants.
K42.9: Umbilical hernia without obstruction or gangrene
- Used for umbilical hernia repairs in infants, requiring anesthesia.
K43.9: Ventral hernia without obstruction or gangrene
- Pertains to ventral hernia repairs, relevant for anesthesia in the lower abdomen.
K44.9: Diaphragmatic hernia without obstruction or gangrene
- Applies to diaphragmatic hernia repairs, where anesthesia is provided for infants.

Each diagnosis code represents a type of hernia repair in the lower abdomen for which anesthesia services described by CPT code 00834 may be provided in infants younger than 1 year of age.

Related CPT Codes

00830: Anesthesia for hernia repairs in lower abdomen; not otherwise specified
- Used for lower abdominal hernia repairs in patients not meeting the age criteria of 00834.
00832: Anesthesia for hernia repairs in lower abdomen; ventral and incisional hernias
- Specifically for ventral and incisional hernia repairs, may be used as an alternative depending on hernia type.
00836: Anesthesia for hernia repairs in the lower abdomen not otherwise specified, infants younger than 37 weeks gestational age at birth and younger than 50 weeks gestational age at time of surgery
- Used for infants with specific gestational age criteria, often in neonatal cases.

These codes are related to 00834 and may be used as alternatives based on patient age, hernia type, and clinical scenario. They are not typically reported together but selected according to the specific procedure and patient characteristics.

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Summary & Overview

CPT 00834: Anesthesia for Pediatric Lower Abdominal Hernia Repair

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00834anesthesiahernia repairpediatric surgeryoutpatient hospitalmedical billingpolicy updateclinical codingbenchmarkingcompliance

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier 99100: Indicates anesthesia for patients of extreme age (younger than 1 year or older than 70). According to guidelines, do not report modifier 99100 with CPT code 00834 as a qualifier.

Modifier Code	Description	Usage Guidance
`99100`	Anesthesia for patient of extreme age, younger than 1 year and older than 70	Not reported with `00834`

Provider Taxonomies:

Taxonomy Code	Specialty
`207L00000X`	Anesthesiology
`207LA0401X`	Pain Medicine (Anesthesiology)
`207LP2900X`	Pediatric Anesthesiology

These taxonomies represent providers specializing in anesthesia, pain medicine, and pediatric anesthesia, all relevant for the procedure described by CPT code 00834.

Related Diagnoses

K40.90: Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent
- Relevant for infants undergoing anesthesia for inguinal hernia repair.
K41.90: Unilateral femoral hernia, without obstruction or gangrene, not specified as recurrent
- Indicates femoral hernia repair, applicable for anesthesia services in infants.
K42.9: Umbilical hernia without obstruction or gangrene
- Used for umbilical hernia repairs in infants, requiring anesthesia.
K43.9: Ventral hernia without obstruction or gangrene
- Pertains to ventral hernia repairs, relevant for anesthesia in the lower abdomen.
K44.9: Diaphragmatic hernia without obstruction or gangrene
- Applies to diaphragmatic hernia repairs, where anesthesia is provided for infants.

Each diagnosis code represents a type of hernia repair in the lower abdomen for which anesthesia services described by CPT code 00834 may be provided in infants younger than 1 year of age.

Related CPT Codes

00830: Anesthesia for hernia repairs in lower abdomen; not otherwise specified
- Used for lower abdominal hernia repairs in patients not meeting the age criteria of 00834.
00832: Anesthesia for hernia repairs in lower abdomen; ventral and incisional hernias
- Specifically for ventral and incisional hernia repairs, may be used as an alternative depending on hernia type.
00836: Anesthesia for hernia repairs in the lower abdomen not otherwise specified, infants younger than 37 weeks gestational age at birth and younger than 50 weeks gestational age at time of surgery
- Used for infants with specific gestational age criteria, often in neonatal cases.

National Reimbursement Benchmarks

Nationally, the mean rate for CPT code 00834 among commercial payers (BUCA) is $147.54, which is substantially higher than the UnitedHealth Group mean rate of $65.57. Blue Cross Blue Shield and Cigna report even higher mean rates at $272.64 and $299.28, respectively, while Aetna's mean rate stands at $205.13.

Rate dispersion varies significantly across payers. Cigna exhibits the widest spread, with a difference of $344.00 between the 75th and 25th percentiles, indicating substantial variability in reimbursement. In contrast, UnitedHealth Group shows the tightest range, with only $25.30 separating its 75th and 25th percentiles, suggesting more consistent rates. Blue Cross Blue Shield and Aetna also display considerable dispersion, but less than Cigna.

The table and chart below present a detailed 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 00834, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($96.90), while Aetna and UnitedHealth Group have minimal spread ($0.00 and $4.00, respectively). This indicates that some payers maintain consistent rates, while others have substantial variability. Compared to national averages, Blue Cross Blue Shield and BUCA payers in Alaska offer higher mean rates, whereas Cigna and UnitedHealth Group reimburse at lower levels than their national benchmarks.

The table and chart below present the full breakdown of mean rates and percentile values for each payer in Alaska, highlighting the differences in reimbursement across the major commercial insurers.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00834 in Alaska, with a mean rate of $329.86.
UnitedHealth Group offers the lowest mean rate at $75.12.
Cigna and UnitedHealth Group both pay significantly less in Alaska compared to their national averages, while Blue Cross Blue Shield pays notably more than the national mean.

Related Codes

00868

CPT 00868: Anesthesia for Renal Transplantation, Lower Abdominal Surgery

00842

CPT 00842: Anesthesia for Lower Anterior Abdominal Wall Procedures

00802

CPT 00802: Anesthesia for Lower Anterior Abdominal Wall Procedures

00810

CPT 00810: Anesthesia for Lower Intestinal Endoscopic Procedures

00880

CPT 00880: Anesthesia for Major Lower Abdominal Vessel Procedures

00865

CPT 00865: Anesthesia for Radical Prostatectomy, Lower Abdomen Procedures

00756

CPT 00756: Anesthesia for Procedures on the Upper Abdomen

00820

CPT 00820: Anesthesia for Lower Abdominal Procedures

00750

CPT 00750: Anesthesia for Upper Abdominal Hernia Repair

00844

CPT 00844: Anesthesia for Lower Abdominal Intraperitoneal Procedures

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National Reimbursement Benchmarks

The table and chart below present a detailed breakdown of national benchmarks for each payer.

National Mean Rates for CPT Code 00834 by Payer

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

The table and chart below present the full breakdown of mean rates and percentile values for each payer in Alaska, highlighting the differences in reimbursement across the major commercial insurers.

Mean CPT 00834 Reimbursement Rates by Payer in Alaska

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00834 in Alaska, with a mean rate of $329.86.
UnitedHealth Group offers the lowest mean rate at $75.12.
Cigna and UnitedHealth Group both pay significantly less in Alaska compared to their national averages, while Blue Cross Blue Shield pays notably more than the national mean.