CPT 00918: Anesthesia for Stone Removal Procedures - OpenPayer

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Summary & Overview

CPT 00918: Anesthesia for Stone Removal Procedures

CPT code 00918 represents anesthesia services provided during stone removal procedures, a critical component in surgical care for patients with urinary or genital stones. This code is widely recognized across the United States and is used by providers to document and bill for anesthesia care in outpatient hospital settings. The publication covers key payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, offering a comprehensive overview of payer coverage and policy considerations for this code.

Readers will gain insight into the clinical context of stone removal anesthesia, typical sites of service, and relevant billing practices. The summary includes information on common modifiers, associated provider taxonomies, and ICD-10 diagnoses frequently linked to stone removal procedures. Additionally, related CPT codes for anesthesia in similar anatomical regions are discussed, providing a broader understanding of coding practices in urologic and genital surgeries. This resource is designed to inform healthcare professionals, billing specialists, and policy analysts about current benchmarks, policy updates, and clinical nuances associated with CPT 00918.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00918anesthesiastone removaloutpatient hospitalmedical billingurologygenital surgeryclinical codingpolicy updatebenchmarks

CPT Code Overview

CPT 00918 is designated for anesthesia services related to stone removal procedures. This code is used to report the administration of anesthesia during surgical interventions aimed at removing stones, typically within the urinary tract or genital organs. The service type is anesthesia, and the typical site of service is an outpatient hospital setting (POS 22). This code is essential for accurately documenting and billing anesthesia care provided during stone removal surgeries, ensuring proper reimbursement and compliance with national billing standards.

Clinical & Coding Specifications

Clinical Context

A patient presents to an outpatient hospital with symptoms related to a disorder of the male genital organs, such as phimosis, balanitis, or unspecified inflammation. The urologist determines that stone removal is necessary, which may involve the bladder, urethra, or other parts of the lower urinary tract. An anesthesia provider, such as an anesthesiologist or certified registered nurse anesthetist (CRNA), administers anesthesia to ensure patient comfort and safety during the stone removal procedure. The clinical workflow includes preoperative assessment, anesthesia induction, monitoring throughout the procedure, and postoperative recovery.

Coding Specifications

Modifier Code	Description	When Used
`QS`	Monitored anesthesia care service	Used when the anesthesia provider delivers monitored anesthesia care (MAC) during the procedure.
`QX`	CRNA service with medical direction by a physician	Used when a CRNA provides anesthesia services under the medical direction of a physician.

Provider Taxonomies:

National Reimbursement Benchmarks

National mean rates for CPT code 00918 show that commercial payers such as Aetna, Blue Cross Blue Shield, Cigna, and BUCA (average commercial) reimburse at significantly higher levels than UnitedHealth Group. The mean rate for BUCA is $179.44, while UnitedHealth Group is much lower at $65.62. Medicare data is not available in the input, so a direct comparison is not possible.

Rate dispersion varies notably across payers. Aetna exhibits the widest spread, with a difference of $415.30 between the 75th and 25th percentiles, indicating substantial variability in contracted rates. Blue Cross Blue Shield and Cigna also show considerable dispersion, at $163.89 and $344.00 respectively. UnitedHealth Group has the tightest range, with only $25.44 separating the 75th and 25th percentiles, suggesting more consistent rates.

The table and chart below present a detailed breakdown of national benchmarks for each payer.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska displays a wide spread in reimbursement rates for CPT code 00918, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($96.90), while Aetna, Cigna, and UnitedHealth Group have much narrower spreads (all under $30). This indicates that Blue Cross Blue Shield's rates are not only the highest on average but also more variable compared to other payers in the state.

Compared to national averages, Blue Cross Blue Shield and BUCA rates in Alaska are notably higher, while Cigna and UnitedHealth Group are well below their national means. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these differences and the overall distribution across the major commercial payers.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00918 in Alaska, with a mean rate of $330.33.
UnitedHealth Group is the lowest paying payer, with a mean rate of $75.12.
Cigna and UnitedHealth Group rates in Alaska are significantly below their respective national averages, while Blue Cross Blue Shield rates are notably higher than the national mean.

Related Codes

00942

CPT 00942: Anesthesia for Vaginal and Associated Procedures

00948

CPT 00948: Anesthesia for Procedures on the Perineum

01190

CPT 01190: Anesthesia Services in Inpatient Hospital (Deleted Code)

00940

CPT 00940: Anesthesia for Female Perineum Procedures

01173

CPT 01173: Anesthesia for Pelvic Procedures (Except Hip)

00936

CPT 00936: Anesthesia for Perineal Procedures with Lymphadenectomy

00912

CPT 00912: Anesthesia for Transurethral Resection of Bladder Tumor

01120

CPT 01120: Anesthesia for Procedures on Bony Pelvis

00934

CPT 00934: Anesthesia for Lower Abdominal Hernia Repairs

00952

CPT 00952: Anesthesia for Procedures on the Perineum

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