CPT 00906 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 00906: Anesthesia for Perineal Procedures, Not Otherwise Specified

CPT code 00906 covers anesthesia for procedures on the perineum that are not otherwise specified, providing a critical billing option for anesthesiology services in cases where more specific codes do not apply. This code is relevant for a variety of clinical scenarios, including pain management and surgical interventions involving the perineal region. Nationally, the code is recognized by major commercial payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage for outpatient hospital procedures.

Readers will gain insight into the clinical context of 00906, including its typical use in outpatient hospital settings and its role within the broader anesthesiology service line. The publication also highlights associated modifiers, relevant taxonomies, and common ICD-10 diagnoses linked to perineal procedures. Additionally, comparisons to related CPT codes provide clarity on when 00906 should be used versus other anesthesia codes. Policy updates and reimbursement benchmarks are discussed to inform stakeholders about current trends and payer requirements. This summary serves as a comprehensive resource for understanding the national landscape of anesthesia billing for perineal procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00906anesthesiologyoutpatient hospitalperineum proceduresmedical billingclinical codingmodifier codesICD-10 diagnosesprocedure reimbursementhealthcare policy

CPT Code Overview

CPT code 00906 is used to report anesthesia services for procedures performed on the perineum 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 designed to capture anesthesia care for a range of perineal procedures where no more specific anesthesia code applies.

Clinical & Coding Specifications

Clinical Context

A patient presents to the outpatient hospital with pelvic or perineal pain, inflammation, or other disorders affecting the perineal region. The clinical workflow involves preoperative assessment by an anesthesiologist or certified registered nurse anesthetist (CRNA), followed by administration of anesthesia for a surgical or diagnostic procedure on the perineum. The procedure is not otherwise specified, meaning it does not fall under more specific CPT codes for perineal or genital procedures. The anesthesia provider monitors the patient throughout the procedure, ensuring safety and comfort, and may use monitored anesthesia care or provide anesthesia under medical direction.

Coding Specifications

Modifiers:

Modifier Code Description
QS Monitored anesthesia care service
QX CRNA service with medical direction by a physician
- Modifier QS is used when the anesthesia service is provided as monitored anesthesia care.

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

National Reimbursement Benchmarks

National mean rates for CPT code 00906 show significant variation between commercial payers and Medicare. The average commercial rate (BUCA) is $134.39, while UnitedHealth Group (UHC), which is used as a proxy for Medicare in this context, has a mean rate of $65.57. This indicates that commercial payers generally reimburse at higher levels than Medicare.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies notably across payers. Blue Cross Blue Shield exhibits the tightest range ($314.00 - $168.75 = $145.25), while Cigna has the widest ($348.00 - $90.00 = $258.00). Aetna and BUCA also show substantial spreads, suggesting considerable variability in contracted rates. UnitedHealth Group has the smallest dispersion ($75.33 - $50.33 = $25.00), indicating more consistent reimbursement levels.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska shows a wide spread in reimbursement rates for CPT code 00906, with Blue Cross Blue Shield offering the highest mean rate at $269.25 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 ($74.20), indicating significant variability in payments, while Aetna and UnitedHealth Group have minimal spreads ($0.00 and $4.00, respectively), suggesting more uniform rates. Cigna also displays a narrow spread ($8.00).

Compared to national averages, Alaska's mean rates for Aetna and Blue Cross Blue Shield are notably higher, while Cigna and UnitedHealth Group are below their respective national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska for CPT code 00906.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00906 in Alaska, with a mean rate of $269.25.
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 are higher than national benchmarks, except for Cigna and UnitedHealth Group, which are notably lower.

Related Codes

00918-ANESTHESIA-STONE

CPT 00918: Anesthesia for Stone Removal Procedures

00910-ANESTHESIA-FOR-TRANSURETHRAL-PROCEDURES-INCLUDING

CPT 00910: Anesthesia for Transurethral Procedures

00948-UNDER-ANESTHESIA-FOR-PROCEDURES-ON-THE

CPT 00948: Anesthesia for Procedures on the Perineum

00942-UNDER-ANESTHESIA-FOR-PROCEDURES-ON-THE-FEMALE-VAGINA-AND

CPT 00942: Anesthesia for Vaginal and Associated Procedures

00914-ANESTHESIA-FOR-PROCEDURES-ON-MALE-GENITALIA-INCLUDING-OPEN

CPT 00914: Anesthesia for Vasectomy Procedures

00930-ANESTHESIA-FOR-PROCEDURES-ON-MALE-GENITALIA-INCLUDING-OPEN

CPT 00930: Anesthesia for Orchiopexy, Unilateral or Bilateral

00916-ANESTHESIA-FOR-PROCEDURE-TO-CONTROL-URINARY-SYSTEM-BLEEDING

CPT 00916: Anesthesia for Urinary System Bleeding Procedures with Endoscope

00952-ANESTHESIA-FOR-PROCEDURES-ON-THE

CPT 00952: Anesthesia for Procedures on the Perineum

00922-ANESTHESIA-FOR-PROCEDURES-ON-MALE-GENITALIA-INCLUDING-OPEN

CPT 00922: Anesthesia for Vasectomy Procedures on Male Genitalia

00912-ANESTHESIA-FOR-TRANSURETHRAL-PROCEDURES-INCLUDING

CPT 00912: Anesthesia for Transurethral Resection of Bladder Tumor

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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.

Provider Taxonomies:

Taxonomy Code	Specialty Name
`207L00000X`	Anesthesiology
`367500000X`	Certified Registered Nurse Anesthetist
`207LA0401X`	Pain Medicine (Anesthesiology)

Anesthesiology (207L00000X): Physicians specializing in anesthesia.
Certified Registered Nurse Anesthetist (367500000X): CRNAs providing anesthesia care.
Pain Medicine (Anesthesiology) (207LA0401X): Anesthesiologists with a focus on pain management.

OpenPayer

Summary & Overview

CPT 00906: Anesthesia for Perineal Procedures, Not Otherwise Specified

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