CPT 00842 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 00842: Anesthesia for Lower Anterior Abdominal Wall Procedures

Headline: CPT 00842: Anesthesia for Lower Anterior Abdominal Wall Procedures

Lead: CPT 00842 denotes anesthetic services provided for procedures on the lower anterior abdominal wall and is relevant across outpatient surgical settings where hernia repairs and related abdominal wall operations are performed. The code captures the anesthesia component distinct from the surgical procedure and is used by anesthesiology clinicians in perioperative billing.

What this code represents and why it matters: CPT 00842 identifies the anesthetic service for a defined anatomical region, ensuring separation of professional anesthesia work from the surgical procedure code. Nationally, consistent use of the code supports accurate billing, resource allocation, and claims validation for anesthesia teams in ambulatory hospital settings.

Key payers covered: This summary addresses major commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.

Overview of reader takeaways: Readers will find guidance on clinical context for CPT 00842, typical procedural pairings (such as hernia repairs), common billing modifiers and clinician taxonomies associated with the service, and the relevant ICD-10 diagnostic linkages used to support medical necessity. The publication provides benchmarks and policy context related to coding and payer coverage practices where available, and notes when specific data are not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00842AnesthesiologyAbdominal WallOutpatient SurgeryHernia RepairAnesthesia BillingSurgical AnesthesiaPerioperative Care

CPT Code Overview

CPT 00842 describes anesthesia for procedures on the lower anterior abdominal wall. This code is used by anesthesia clinicians to report provision of anesthetic care when surgical or procedural interventions target the lower anterior abdominal region. The service type is Anesthesiology and the typical site of service is Outpatient Hospital (POS 22).

Clinical & Coding Specifications

Clinical Context

A typical outpatient adult patient presents for elective repair of a hernia located on the lower anterior abdominal wall (for example, an inguinal, femoral, umbilical, or ventral hernia). The patient is evaluated preoperatively in the outpatient hospital setting (POS 22), reviewed for medical history, allergies, and anesthesia risk. The anesthesia team (anesthesiologist or CRNA) provides an anesthesia plan consistent with the surgical approach (open or laparoscopic hernia repair). Intraoperative management includes induction, maintenance, monitoring of vital signs, airway management as needed, and postoperative emergence and handoff to recovery. Perioperative documentation includes the anesthesia start and stop times, technique, airway device, medications administered, monitoring modalities, and any intraoperative events relevant to the anesthetic for the lower anterior abdominal wall procedure.

Coding Specifications

Modifiers
QS - Monitored anesthesia care service. Use when anesthesia is provided as monitored anesthesia care (MAC) rather than general anesthesia, regional block alone, or sedation without anesthesia provider documentation inconsistent with MAC billing.
QX - CRNA service with medical direction by a physician. Use when a Certified Registered Nurse Anesthetist (CRNA) furnishes the anesthesia service and the service is medically directed by a physician under applicable supervision rules.
Provider Taxonomies

National Reimbursement Benchmarks

National mean commercial rates exceed Medicare when compared with BUCA (the average commercial benchmark): the BUCA mean rate is $123.21 while the implied Medicare value is not provided in the input (reported here as $0.00 to indicate no Medicare mean present in the provided data). Blue Cross Blue Shield shows the highest national mean at $281.14, followed by Cigna at $156.99 and Aetna at $145.83; UnitedHealth Group has the lowest reported commercial mean at $65.63.

Rate dispersion, measured as the difference between the 75th and 25th percentiles, is widest for Blue Cross Blue Shield (range $141.97) and Aetna (range $220.00), indicating substantial variability in paid rates. Dispersion is tightest for Cigna (range $13.76) and UnitedHealth Group (range $25.47), reflecting more concentrated rate distributions for those payers. The table and chart below present the full percentile and mean breakdown for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska shows a significant spread in reimbursement rates for CPT code 00842, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $75.38. Aetna and UnitedHealth Group display minimal rate variation, with all percentiles clustered closely around $72, indicating limited negotiation or variation in contracted rates. Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and Aetna 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 rates for CPT code 00842 in Alaska, highlighting the differences in mean and percentile values across the major commercial payers.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00842 in Alaska, with a mean rate of $269.45.
UnitedHealth Group offers the lowest mean rate in Alaska at $75.12.
Alaska's mean rates for most payers are higher than national averages, except for Cigna and UnitedHealth Group, which are below their respective national means.

CPT 00868: Anesthesia for Renal Transplantation, Lower Abdominal Surgery

00834-ANESTHESIA-FOR-HERNIA-REPAIRS-IN-THE-LOWER-ABDOMEN-NOT

CPT 00834: Anesthesia for Pediatric Lower Abdominal Hernia Repair

00846-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-LOWER-ABDOMEN

CPT 00846: Anesthesia for Lower Abdominal Intraperitoneal Procedures

00848-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-LOWER-ABDOMEN

CPT 00848: Anesthesia for Pelvic Exenteration in Lower Abdomen

00860-ANESTHESIA-FOR-EXTRAPERITONEAL-PROCEDURES-IN-LOWER-ABDOMEN

CPT 00860: Anesthesia for Extraperitoneal Lower Abdominal Procedures

00832-ANESTHESIA-FOR-PROCEDURES-IN-LOWER-ABDOMEN-INCLUDING

CPT 00832: Anesthesia for Lower Abdominal Procedures Including Colonoscopy

00864-ANESTH-REMOVAL-OF

CPT 00864: Anesthesia for Bladder Removal Surgery

00866-ANESTHESIA-FOR-PROCEDURES-IN-LOWER-ABDOMEN-INCLUDING

CPT 00866: Anesthesia for Lower Abdomen Procedures Including Colonoscopy

00851-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-LOWER-ABDOMEN

CPT 00851: Anesthesia for Intraperitoneal Procedures in Lower Abdomen

00862-ANESTHESIA-SERVICES-FOR-PROCEDURES-IN-THE-LOWER-ABDOMEN

CPT 00862: Anesthesia for Lower Abdomen and Renal Procedures

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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
`49505`	Repair initial inguinal hernia, age 5 years or older; reducible
`49585`	Repair umbilical hernia, age 5 years or older; reducible
`49650`	Laparoscopy, surgical; repair initial inguinal hernia
`49560`	Repair initial incisional or ventral hernia; reducible

49505 relates as the common open surgical procedure for an inguinal hernia; anesthesia for this procedure is reported with the primary anesthesia code for lower anterior abdominal wall procedures.
49585 relates as the common open surgical procedure for umbilical hernia repair; anesthesia for this procedure is reported under the same anesthesia code when the surgical site is the lower anterior abdominal wall.
49650 is a laparoscopic approach to inguinal hernia repair; the anesthesia code for lower anterior abdominal wall procedures applies to both open and laparoscopic approaches, and 49650 may be used as the operative code in the surgical claim while 00842 describes the anesthesia service.
49560 is repair of incisional or ventral hernia; when located on the lower anterior abdominal wall, the anesthesia service for this operation is reported with the primary anesthesia code for that anatomic region.
Common pairings/alternatives: The listed surgical CPT codes are commonly paired with the anesthesia code for lower anterior abdominal wall procedures (00842) as the corresponding anesthesia service; choice among these surgical codes depends on the specific hernia type, approach (open versus laparoscopic), and intraoperative findings.

`207L00000X`	Anesthesiology Physician
`367500000X`	Certified Registered Nurse Anesthetist
`207LA0401X`	Pain Medicine (Anesthesiology)

OpenPayer

Summary & Overview

CPT 00842: Anesthesia for Lower Anterior 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