CPT 00930: Anesthesia for Orchiopexy, Unilateral or Bilateral - OpenPayer

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Summary & Overview

CPT 00930: Anesthesia for Orchiopexy, Unilateral or Bilateral

Headline: CPT 00930: Anesthesia for Orchiopexy — Scope and Coverage Overview

Lead: CPT 00930 designates anesthesia provided for orchiopexy (unilateral or bilateral), a common pediatric and urologic surgical procedure to correct undescended testicles. The code frames billing and coverage discussions for anesthesia teams, hospital billing departments, and payers across commercial plans.

What the code represents and why it matters: CPT 00930 identifies the anesthesia component of surgical care for male genital procedures when an orchiopexy is performed. Anesthesia coding affects facility and professional payments, service authorization processes, and procedural workflow in outpatient hospital settings. Nationally, consistent use of this code supports accurate claims adjudication, quality tracking, and resource planning for perioperative services.

Key payers covered: This overview addresses coverage relevance for Aetna; Blue Cross Blue Shield; Cigna Health; and UnitedHealthcare. These major commercial payers commonly adjudicate anesthesia claims for outpatient surgical sites and have varying medical necessity and documentation requirements.

What readers will learn: The publication provides benchmarks and clinical context for CPT 00930, summarizes payer coverage considerations, and situates the code alongside related anesthesia practice conventions. It highlights typical site-of-service implications and outlines where to find further details on modifiers, diagnosis coding, and related CPT entries. Data not available in the input is explicitly noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00930AnesthesiaOrchiopexyOutpatient HospitalSurgical CodingPediatric UrologyProcedure BillingCode DefinitionsPerioperative Care

CPT Code Overview

CPT 00930 describes anesthesia services provided for procedures on male genitalia, specifically for orchiopexy, unilateral or bilateral. This code is used when anesthesia is administered to facilitate surgical correction of undescended testicle(s).

Service Type: Anesthesia

Typical Site of Service: Outpatient Hospital (POS 22)

Clinical & Coding Specifications

Clinical Context

A typically healthy pediatric or young adult male presents to an outpatient hospital surgical suite for elective orchiopexy under general anesthesia. The patient has an undescended testis identified on physical exam and confirmed by ultrasound; the procedure is unilateral or bilateral depending on findings. Preoperative evaluation in the pre-op clinic includes a focused history and physical, airway assessment, medication reconciliation, and anesthesia consent. On the day of surgery, anesthesia induction occurs in the preoperative area with standard monitoring; the patient is transported to the operating room where a general endotracheal anesthesia or laryngeal mask airway is used per anesthesiologist discretion. Intraoperative care includes airway management, hemodynamic monitoring, analgesia, and potential regional blocks if indicated. Postoperative recovery occurs in the post-anesthesia care unit with assessment of pain control, nausea management, and discharge planning to home when criteria are met.

Coding Specifications

Modifiers
QS : Monitored anesthesia care service. Use when the anesthesia service provided is monitored anesthesia care (MAC) rather than general or regional anesthesia.
QX : CRNA service with medical direction by a physician. Use when a certified registered nurse anesthetist (CRNA) furnishes the anesthesia service and a physician medically directs the CRNA.
Provider Taxonomies and Specialties

National Reimbursement Benchmarks

National mean allowed rates place Medicare well below the average commercial benchmark (BUCA). The average commercial mean (BUCA) is $139.12, whereas Medicare is not provided in the input and is represented as $0.00 for comparison purposes, indicating Data not available in the input for Medicare means.

Rate dispersion (P75 minus P25) varies substantially by payer. Cigna shows one of the widest spreads (P75 $348.00 vs P25 $90.00), while UnitedHealth Group is among the tightest (P75 $75.71 vs P25 $50.20). Blue Cross Blue Shield and Aetna show moderate dispersion, and BUCA exhibits a mid-range spread. The table and chart below present the full breakdown.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska demonstrates a wide rate spread for CPT code 00930, particularly among Blue Cross Blue Shield and BUCA, where the difference between the 75th and 25th percentiles exceeds $74 and $124 respectively. This indicates substantial variability in reimbursement depending on payer and provider contracts. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal rate spread, with most percentile values clustered closely together, suggesting more uniform payment structures.

Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably higher, while UnitedHealth Group and Cigna are below or near national benchmarks. The table and chart below present the full breakdown of payer-specific rates and percentiles for Alaska, highlighting the state's unique reimbursement landscape.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00930 in Alaska, with a mean rate of $269.24.
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 Blue Cross Blue Shield and BUCA, are notably higher than their respective national averages, indicating a premium reimbursement environment.

Related Codes

00904

CPT 00904: Anesthesia for Male Genitalia Procedures

01180

CPT 01180: Anesthesia for Lower Leg, Ankle, and Foot Procedures

00926

CPT 00926: Anesthesia for Procedures on the Perineum

01160

CPT 01160: Anesthesia for Pelvic Procedures (Except Hip)

01190

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

00934

CPT 00934: Anesthesia for Lower Abdominal Hernia Repairs

00918

CPT 00918: Anesthesia for Stone Removal Procedures

00950

CPT 00950: Anesthesia for Culdoscopy Including Biopsy

01173

CPT 01173: Anesthesia for Pelvic Procedures (Except Hip)

01112

CPT 01112: Anesthesia for Bone Marrow Aspiration or Biopsy, Iliac Crest

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