Summary & Overview
CPT 00904: Anesthesia for Male Genitalia Procedures
CPT code 00904 represents anesthesia services for procedures on male genitalia, including open urethral procedures not otherwise specified. This code is significant for hospitals and anesthesia providers nationwide, as it ensures proper billing and reimbursement for a variety of surgical interventions involving the male genitalia. The code is most frequently used in outpatient hospital settings, reflecting the trend toward ambulatory surgical care.
Major national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides an overview of payer coverage, typical clinical scenarios, and relevant policy updates. Readers will gain insight into the clinical context for the use of 00904, including common diagnoses such as phimosis, paraphimosis, balanitis, benign prostatic hyperplasia with lower urinary tract symptoms, and inflammatory disorders of the penis. The summary also highlights related CPT codes for procedures commonly associated with anesthesia services under 00904.
This article offers benchmarks for utilization, discusses modifier usage, and outlines associated provider taxonomies. It is designed to inform healthcare professionals, billing specialists, and policy analysts about the key aspects of anesthesia billing for male genital procedures, supporting accurate coding and compliance with payer requirements.
CPT Code Overview
CPT code 00904 is used to report anesthesia services for procedures performed on male genitalia, including open urethral procedures that are not otherwise specified. This code falls under the Anesthesiology service type and is most commonly utilized in the Outpatient Hospital setting (Place of Service 22). The code is essential for accurately documenting and billing anesthesia care provided during a range of surgical interventions involving the male genitalia.
Clinical & Coding Specifications
Clinical Context
A male patient presents to the outpatient hospital with a urological condition such as phimosis, paraphimosis, balanitis, benign prostatic hyperplasia with lower urinary tract symptoms, or an inflammatory disorder of the penis. The patient is scheduled for a surgical procedure on the male genitalia, which may include open urethral procedures. An anesthesiologist provides anesthesia services to ensure patient comfort and safety during the operation. The procedure is performed in an outpatient setting, and the patient is typically healthy, as indicated by modifier P1. Monitored anesthesia care may be provided, as indicated by modifier QS.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesiologist provides monitoring and support during the procedure, rather than full general anesthesia.P1: A normal healthy patient. Indicates the patient has no systemic disease and is classified as ASA Physical Status 1.
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Provider Taxonomies:
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