CPT 00873 Anesthesia Reimbursement Benchmarks | OpenPayer

Summary & Overview

CPT 00873: Anesthesia for Extracorporeal Shock Wave Lithotripsy

CPT 00873 covers anesthesia provided during extracorporeal shock wave lithotripsy (ESWL), a noninvasive treatment for urinary tract and kidney stones. Nationally, this code is important because it identifies anesthesia resources and clinical complexity associated with ESWL procedures performed in hospital settings. It supports accurate billing and classification of anesthetic care when patients require sedation or general anesthesia for shock wave lithotripsy.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find a concise explanation of the code and its clinical context, information on common modifiers and provider taxonomies associated with anesthesia delivery, and related CPT entries for comparable anesthesia services. The publication also covers typical ICD-10 diagnoses encountered with procedures requiring ESWL and cross-references related anesthesia codes to clarify coding choices.

The content is organized to provide a quick reference for coding staff, billing teams, and policy analysts seeking clarity on service classification, payer coverage scope, and adjacent codes. Data gaps are noted where input information is incomplete. The goal is to offer a clear, national-level summary of what CPT 00873 represents and where it fits within anesthesia service coding.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00873AnesthesiaExtracorporeal Shock Wave LithotripsyInpatient HospitalESWLAnesthesiologyCodingICD-10

CPT Code Overview

CPT 00873 describes anesthesia care provided under anesthesia for lithotripsy, extracorporeal shock wave. This code is used for anesthesia services rendered while a patient undergoes extracorporeal shock wave lithotripsy, a noninvasive procedure that uses focused shock waves to break up stones in the kidney or urinary tract. The service type is Anesthesia and the typical site of service is Inpatient Hospital (POS 21).

Clinical & Coding Specifications

Clinical Context

A patient with symptomatic knee osteoarthritis or a history of prior knee arthroplasty is scheduled for extracorporeal shock wave lithotripsy under general or monitored anesthesia in an inpatient hospital setting (POS 21). The typical workflow: preoperative assessment by the anesthesia team, verification of applicable diagnoses and prior joint status, administration of anesthesia (general, regional, or monitored anesthesia care) for the lithotripsy procedure, intraoperative hemodynamic and airway management, postoperative recovery in the hospital and handoff to nursing staff. The anesthesia encounter documents start and end times, the anesthesia technique, monitoring, any intraoperative events, and use of modifiers where applicable.

Coding Specifications

Common modifiers:
QS : Monitored anesthesia care service. Use when the anesthesia provided is monitored anesthesia care rather than general anesthesia for the lithotripsy procedure.
QX : CRNA service with medical direction by a physician. Use when a Certified Registered Nurse Anesthetist delivers the anesthesia service under the medical direction of an anesthesiologist.
Associated provider taxonomies:

Taxonomy Code	Specialty

National Reimbursement Benchmarks

National mean rates show a clear gap between Medicare and BUCA (the average commercial benchmark): Medicare data is not available in the input, while BUCA reports a mean rate of $149.60, indicating commercial averages are present but Medicare comparators cannot be calculated from the provided dataset. The table and chart below present the full breakdown of available payer rate metrics.

Rate dispersion (P75 minus P25) varies notably across payers. Cigna and Aetna show the widest spread (Cigna: $344.00; Aetna: $306.33), indicating larger variability in rates, while UnitedHealth Group is the tightest (UHC: $25.33), reflecting relatively narrow dispersion. The table and chart below present the full breakdown.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a significant rate spread for CPT code 00873, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $96.90. Aetna, Cigna, and UnitedHealth Group show minimal rate variation, with spreads of $0 to $4, indicating highly standardized reimbursement. 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 mean rates and percentile distributions for each payer in Alaska, highlighting the substantial differences in reimbursement across payers.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00873 in Alaska, with a mean rate of $330.57.
UnitedHealth Group offers the lowest mean rate 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 00834: Anesthesia for Pediatric Lower Abdominal Hernia Repair

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

CPT 00860: Anesthesia for Extraperitoneal Lower Abdominal Procedures

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

CPT 00846: Anesthesia for Lower Abdominal Intraperitoneal Procedures

00882-UNDER-ANESTHESIA-FOR-PROCEDURES-ON-THE-LOWER

CPT 00882: Anesthesia for Lower Abdomen Procedures

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

CPT 00851: Anesthesia for Intraperitoneal Procedures in Lower Abdomen

CPT-00813-ANESTHESIA-COMBINED-UPPER-LOWER-INTESTINAL-ENDOSCOPY

CPT 00813: Anesthesia for Combined Upper and Lower Intestinal Endoscopy

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

CPT 00865: Anesthesia for Radical Prostatectomy, Lower Abdomen Procedures

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

CPT 00862: Anesthesia for Lower Abdomen and Renal Procedures

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

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

00800-ANESTHESIA-FOR-PROCEDURES-ON-LOWER-ABDOMEN-NOT-OTHERWISE

CPT 00800: Anesthesia for Lower Abdominal Procedures

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Related CPT Codes

CPT Code	Description	Relationship to `00873`
`00872`	Anesthesia for lithotripsy, extracorporeal shock wave	Closely related; `00872` and `00873` describe anesthesia for extracorporeal shock wave lithotripsy in different anatomic or procedural contexts and may be used as alternatives depending on the specific procedure performed
`00880`	Under anesthesia for procedures on major lower abdominal vessels	Related by anatomical region and anesthesia service type; may appear in the same clinical setting when vascular procedures are performed in proximity to lithotripsy or when anesthesia coding requires selection of the correct regional anesthesia code

Common usage notes: these codes are used to report the anesthesia service for extracorporeal lithotripsy or nearby lower abdominal vascular procedures. They may be selected as alternatives based on the exact procedure location and operative description. Common pairings occur when multiple procedures under the same anesthesia encounter require appropriate anesthesia coding selection.

`207L00000X`	Anesthesiology — physician anesthesiologists who provide anesthesia care and may medically direct CRNAs
`367500000X`	Certified Registered Nurse Anesthetist — CRNAs who provide anesthesia services, including monitored anesthesia care
`207RA0401X`	Anesthesiology Assistant — anesthesia care team members who assist in delivery of anesthesia under supervision

OpenPayer

Summary & Overview

CPT 00873: Anesthesia for Extracorporeal Shock Wave Lithotripsy

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