CPT 00864 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 00864: Anesthesia for Bladder Removal Surgery

CPT code 00864 covers anesthesia services for the surgical removal of the bladder, a procedure that is significant in the management of various urological and abdominal conditions. This code is nationally recognized and utilized by anesthesiology professionals in outpatient hospital settings to ensure proper billing and documentation for anesthesia care during bladder removal surgeries. The publication provides a comprehensive overview of the clinical context, including the typical site of service and the role of anesthesia in these procedures.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting broad national coverage and relevance for providers and facilities. Readers will gain insights into payer coverage, common billing practices, and the clinical importance of anesthesia in bladder removal. The article also highlights related codes for similar procedures, such as prostate and adrenal removal, and kidney transplant, offering a broader perspective on anesthesia billing in urological surgeries. Policy updates, benchmarks, and clinical context are discussed to inform stakeholders about current trends and requirements for accurate coding and reimbursement.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00864anesthesiabladder removaloutpatient hospitalmedical billingurologysurgical proceduresclinical codingpolicy updatesbenchmarks

CPT Code Overview

CPT code 00864 is designated for anesthesia services provided during the removal of the bladder. This procedure typically occurs in an outpatient hospital setting, classified as Place of Service 22. The service type is anesthesia, which involves the administration and management of medications to ensure patient comfort and safety throughout the surgical removal of the bladder. This code is used by healthcare professionals specializing in anesthesia to accurately document and bill for their services during this complex surgical intervention.

Clinical & Coding Specifications

Clinical Context

A patient presents to the outpatient hospital with symptoms such as abdominal pain, swelling, or evidence of hemoperitoneum. After clinical evaluation, the patient is scheduled for surgical removal of the bladder (cystectomy) due to underlying conditions such as severe peritoneal disorders or masses. An anesthesia provider, typically from the anesthesiology specialty, administers anesthesia services for the procedure. The workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care. The service is performed in an outpatient hospital setting (Place of Service 22).

Coding Specifications

Modifier QS: Indicates that monitored anesthesia care (MAC) was provided during the procedure.
Modifier P1: Used to denote that the patient is a normal, healthy individual undergoing the procedure.

Modifier Code	Description
`QS`	Monitored anesthesia care service

National Reimbursement Benchmarks

National mean rates for CPT code 00864 show significant variation across commercial payers. The BUCA average commercial mean rate is $200.59, while UnitedHealth Group's mean rate is notably lower at $65.51. Blue Cross Blue Shield and Cigna report the highest mean rates, at $405.27 and $454.82 respectively. Aetna's mean rate stands at $291.99.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Cigna ($603.75) and Aetna ($455.00), indicating substantial variability in contracted rates. Blue Cross Blue Shield has a tighter range ($224.23), and UnitedHealth Group shows the narrowest spread ($25.08), suggesting more consistent rates across providers. The table and chart below present the full breakdown of national benchmarks for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska demonstrates a substantial rate spread for CPT code 00864, particularly among Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $173.40 ($594.00 minus $420.60). BUCA also shows a wide spread of $266.40, while Aetna, Cigna, and UnitedHealth Group have minimal spreads, indicating more uniform reimbursement rates. Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are significantly higher, reflecting a premium reimbursement environment in the state.

The table and chart below present the full breakdown of mean rates and percentile distributions for each payer in Alaska. This allows for a clear comparison of how each payer's reimbursement structure differs within the state and relative to national benchmarks.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00864 in Alaska, with a mean rate of $513.58.
UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
Alaska's mean rates for most payers, especially BCBS and BUCA, are notably higher than their respective national averages, indicating a premium reimbursement environment.

CPT 00811: Anesthesia for Lower Intestinal Endoscopic Procedure

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

CPT 00866: Anesthesia for Lower Abdomen Procedures Including Colonoscopy

CPT-00812-ANESTHESIA-COLONOSCOPY-BELOW-DUODENUM

CPT 00812: Anesthesia for Screening Colonoscopy Below the Duodenum

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

CPT 00860: Anesthesia for Extraperitoneal Lower Abdominal Procedures

00868-ANES-XTRPRTL-LWR-ABD-WURIN-TRACT-RENAL

CPT 00868: Anesthesia for Renal Transplantation, Lower Abdominal Surgery

00840-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-LOWER-ABDOMEN

CPT 00840: Anesthesia for Intraperitoneal Procedures in Lower Abdomen

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

CPT 00865: Anesthesia for Radical Prostatectomy, Lower Abdomen Procedures

00844-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-LOWER-ABDOMEN

CPT 00844: Anesthesia for Lower Abdominal Intraperitoneal Procedures

00802-ANESTHESIA-FOR-PROCEDURES-ON-LOWER-ANTERIOR-ABDOMINAL

CPT 00802: Anesthesia for Lower Anterior Abdominal Wall Procedures

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

CPT 00851: Anesthesia for Intraperitoneal Procedures in Lower Abdomen

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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.

Taxonomy Code	Specialty Name
`207L00000X`	Anesthesiology
`207LA0401X`	Anesthesiology Assistant
`207LC0200X`	Critical Care Medicine (Anesthesiology)

OpenPayer

Summary & Overview

CPT 00864: Anesthesia for Bladder Removal Surgery

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