CPT 00942: Anesthesia for Vaginal and Associated Procedures - OpenPayer

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Summary & Overview

CPT 00942: Anesthesia for Vaginal and Associated Procedures

CPT code 00942 covers anesthesia services for surgical procedures involving the female vagina and related structures, such as biopsies, incisions, repairs, excisions, and open urethral operations. This code is nationally significant for anesthesiology practices, ambulatory surgical centers, and hospitals, as it ensures proper billing and reimbursement for anesthesia care during gynecological surgeries. The publication examines coverage and policy considerations from major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.

Readers will gain insight into payer coverage trends, clinical benchmarks, and policy updates relevant to anesthesia services for vaginal procedures. The analysis provides context on typical sites of service, common clinical scenarios, and the importance of accurate coding for compliance and reimbursement. Key modifiers, associated taxonomies, and related codes are also discussed to support understanding of the broader billing landscape. This summary serves as a resource for healthcare professionals, administrators, and policy analysts seeking clarity on CPT 00942 and its role in anesthesia billing for gynecological procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00942anesthesiagynecologyambulatory surgical centermedical billingprocedure codingclinical benchmarkspolicy updatesmodifier codestaxonomies

CPT Code Overview

CPT 00942 is designated for anesthesia services provided during procedures on the female vagina and associated structures. These procedures may include biopsy, incision into the vagina, repair of vaginal tears, excision of the vagina, and open urethral procedures. The service type is anesthesia, and it is most commonly performed in an Ambulatory Surgical Center (Place of Service 24). This code is essential for accurately reporting and reimbursing anesthesia care during gynecological surgeries.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves a female patient presenting to an ambulatory surgical center for a procedure on the vagina or associated structures. This may include a vaginal biopsy, incision into the vagina, repair of a vaginal tear, excision of vaginal tissue, or an open urethral procedure. The patient is assessed preoperatively by an anesthesiologist, who determines the appropriate anesthesia plan. The procedure is performed under anesthesia, with the anesthesiologist monitoring the patient throughout. The workflow includes preoperative evaluation, administration of anesthesia, intraoperative monitoring, and postoperative recovery. The service is typically provided in an ambulatory surgical center (Place of Service 24).

Coding Specifications

Modifier QS: Indicates that monitored anesthesia care (MAC) was provided during the procedure. Used when the anesthesiologist is present and monitoring the patient, but not necessarily providing general anesthesia.
Modifier P1: Denotes that the patient is a normal, healthy individual with no systemic disease. Used to indicate the physical status of the patient for anesthesia risk assessment.

Provider Taxonomy Code	Specialty Name

National Reimbursement Benchmarks

For CPT code 00942, the national mean rate for BUCA (average commercial) is $141.89, which is substantially higher than typical Medicare rates, though Medicare data is not available in the input for this code. Among individual commercial payers, Cigna and Blue Cross Blue Shield have the highest mean rates at $248.92 and $247.58, respectively, while UnitedHealth Group is notably lower at $65.55.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Blue Cross Blue Shield and Cigna exhibit the widest ranges ($151.25 and $258.00, respectively), indicating greater variability in contracted rates. UnitedHealth Group has the tightest range at $25.50, suggesting more consistent reimbursement levels. The table and chart below present the full breakdown of national benchmarks for this code.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska shows a wide spread in reimbursement rates for CPT code 00942 across commercial payers. Blue Cross Blue Shield has the largest rate spread, with a 75th percentile of $300.00 and a 25th percentile of $225.80, resulting in a $74.20 difference. Aetna, Cigna, and UnitedHealth Group all have minimal rate spreads, with their 25th, 50th, and 75th percentiles clustered closely together, indicating limited variability in negotiated rates. The table and chart below present the full breakdown by payer.

Compared to national averages, Blue Cross Blue Shield and BUCA payers in Alaska offer higher mean rates, while Cigna and UnitedHealth Group reimburse at levels below their national benchmarks. This highlights significant regional variation, with Alaska's commercial market showing both premium and discounted rates relative to national norms.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00942 in Alaska, with a mean rate of $269.15.
UnitedHealth Group offers the lowest mean rate at $75.12, significantly below the state average.
Cigna and UnitedHealth Group both pay notably less in Alaska compared to their national averages, while Blue Cross Blue Shield pays above its national mean.

Related Codes

00912

CPT 00912: Anesthesia for Transurethral Resection of Bladder Tumor

00930

CPT 00930: Anesthesia for Orchiopexy, Unilateral or Bilateral

01170

CPT 01170: Anesthesia for Open Symphysis Pubis or Sacroiliac Joint Procedures

00940

CPT 00940: Anesthesia for Female Perineum Procedures

00948

CPT 00948: Anesthesia for Procedures on the Perineum

00952

CPT 00952: Anesthesia for Procedures on the Perineum

00928

CPT 00928: Anesthesia for Radical Abdominal Orchiectomy

00924

CPT 00924: Anesthesia for Undescended Testis Procedures

01130

CPT 01130: Anesthesia for Body Cast Procedure

00914

CPT 00914: Anesthesia for Vasectomy Procedures

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