CPT 00846 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 00846: Anesthesia for Lower Abdominal Intraperitoneal Procedures

CPT code 00846 represents anesthesia for intraperitoneal procedures in the lower abdomen, including laparoscopy and radical hysterectomy. This code is significant for its role in supporting complex gynecological and abdominal surgeries, where specialized anesthesia care is essential for patient outcomes. Nationally, the code is widely utilized in hospital and ambulatory surgical center settings, reflecting its importance in surgical care delivery.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides insights into payer coverage, typical sites of service, and the clinical context for the use of CPT 00846. Readers will learn about relevant modifiers, associated provider taxonomies, and common ICD-10 diagnoses linked to this code. Additionally, the article highlights related CPT codes for similar anesthesia services, offering a comprehensive overview of billing and policy considerations for anesthesia in lower abdominal procedures.

This summary equips healthcare professionals, billing specialists, and policy analysts with essential information on the clinical and administrative aspects of CPT 00846, supporting informed decision-making in anesthesia billing and compliance.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00846anesthesiologyhospitalambulatory surgical centerradical hysterectomylaparoscopymedical billingpolicy updateclinical contextintraperitoneal procedures

CPT Code Overview

CPT 00846 is used to report anesthesia services for intraperitoneal procedures in the lower abdomen, specifically including laparoscopy and radical hysterectomy. This code falls under the anesthesiology service type and is typically performed in a hospital or ambulatory surgical center setting, corresponding to place of service codes 22 or 24. The procedure involves providing anesthesia care for complex surgical interventions within the lower abdominal cavity, ensuring patient safety and comfort during operations such as radical hysterectomy.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves a female patient presenting with a diagnosis such as an unspecified ovarian cyst (N83.20), hemoperitoneum (K66.1), or peritonitis (K65.9). The patient is scheduled for a radical hysterectomy, which is an intraperitoneal procedure performed in the lower abdomen, often using laparoscopy. The procedure is conducted in a hospital or ambulatory surgical center. An anesthesia provider, such as an anesthesiologist or a certified registered nurse anesthetist (CRNA), administers anesthesia services throughout the surgery, ensuring patient safety and comfort during the radical hysterectomy.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider is delivering monitored anesthesia care rather than general anesthesia.
- QX: CRNA service with medical direction by a physician. Used when a CRNA is providing anesthesia under the supervision of a physician.
Provider Taxonomies:
- 207L00000X: Anesthesiology – represents board-certified anesthesiologists.
- 367500000X: Certified Registered Nurse Anesthetist – represents CRNAs.

National Reimbursement Benchmarks

National mean rates for CPT code 00846 show that commercial payers in the BUCA category average $220.54, while UnitedHealth Group is notably lower at $65.70. Blue Cross Blue Shield and Cigna report higher mean rates at $399.55 and $453.18, respectively. Aetna's mean rate stands at $348.39. Medicare data is not available in the input.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. UnitedHealth Group has the tightest range ($25.67), indicating less variability in rates, while Cigna exhibits the widest range ($604.00), reflecting substantial rate variation. Blue Cross Blue Shield and Aetna also show considerable dispersion, with ranges of $219.20 and $511.00, respectively.

The table and chart below present a detailed 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 00846, with Blue Cross Blue Shield offering the highest mean rate at $513.33 and UnitedHealth Group the lowest at $75.12. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($173.40) and BUCA ($270.53), indicating significant variability in payments across payers. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal spread, with their 25th, 50th, and 75th percentiles nearly identical, suggesting consistent rates for most providers.

Compared to national averages, Blue Cross Blue Shield's mean rate in Alaska is substantially higher, while Cigna and UnitedHealth Group reimburse well below their national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these disparities and the overall landscape for CPT code 00846 in the state.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00846 in Alaska, with a mean rate of $513.33.
UnitedHealth Group offers the lowest mean rate at $75.12.
Cigna and UnitedHealth Group both reimburse well below their national averages, while Blue Cross Blue Shield's mean rate in Alaska is notably higher than its national benchmark.

CPT 00866: Anesthesia for Lower Abdomen Procedures Including Colonoscopy

00880-ANESTHESIA-FOR-PROCEDURES-ON-MAJOR-LOWER-ABDOMINAL-VESSELS

CPT 00880: Anesthesia for Major Lower Abdominal Vessel Procedures

00836-ANESTHESIA-FOR-HERNIA-REPAIRS-IN-LOWER-ABDOMEN-PATIENT-IS

CPT 00836: Anesthesia for Lower Abdominal Hernia Repair in Preterm Infants

00872-ANESTHESIA-FOR-EXTRACORPOREAL-SHOCK-WAVE-LITHOTRIPSY

CPT 00872: Anesthesia for Extracorporeal Shock Wave Lithotripsy

CPT-00811-ANESTHESIA-LOWER-INTESTINAL-ENDOSCOPY

CPT 00811: Anesthesia for Lower Intestinal Endoscopic Procedure

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

CPT 00860: Anesthesia for Extraperitoneal Lower Abdominal Procedures

00865-ANESTHESIA-FOR-EXTRAPERITONEAL-PROCEDURES-IN-LOWER-ABDOMEN

CPT 00865: Anesthesia for Radical Prostatectomy, Lower Abdomen Procedures

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

CPT 00832: Anesthesia for Lower Abdominal Procedures Including Colonoscopy

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

CPT 00848: Anesthesia for Pelvic Exenteration 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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Summary & Overview

CPT 00846: Anesthesia for Lower 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

Modifier	Description
`QS`	Monitored anesthesia care service
`QX`	CRNA service with medical direction by a physician

Taxonomy Code	Specialty
`207L00000X`	Anesthesiology
`367500000X`	Certified Registered Nurse Anesthetist
`207RA0401X`	Anesthesiology Assistant