CPT 00952: Anesthesia for Procedures on the Perineum - OpenPayer

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Summary & Overview

CPT 00952: Anesthesia for Procedures on the Perineum

CPT code 00952 is designated for anesthesia services provided during procedures on the perineum, a critical area in surgical care. This code is widely recognized across national payer networks, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The code is primarily utilized in inpatient hospital settings, reflecting the complexity and clinical importance of perineal procedures that often require advanced anesthetic management.

This publication offers a comprehensive overview of CPT 00952, detailing its clinical context, typical use cases, and payer coverage. Readers will gain insights into relevant benchmarks, policy updates, and the role of anesthesia in perineal surgeries. The analysis also highlights common modifiers, associated taxonomies, and related diagnoses, providing a clear understanding of how this code fits within broader billing and clinical workflows. By examining payer coverage and procedural specifics, the article supports healthcare professionals, administrators, and policy analysts in navigating the evolving landscape of anesthesia billing for perineal procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00952anesthesiaperineum proceduresinpatient hospitalmedical billingclinical contextpolicy updatesbenchmarksprocedure codinghealthcare administration

CPT Code Overview

CPT 00952 represents anesthesia services for procedures performed on the perineum. This code is used when anesthesia is administered to patients undergoing surgical interventions in the perineal region. The service type is anesthesia, and the typical site of service is an inpatient hospital setting (POS 21). These procedures often require specialized anesthetic care due to the complexity and sensitivity of the area involved.

Clinical & Coding Specifications

Clinical Context

A patient is admitted to an inpatient hospital (Place of Service 21) for a cardiac procedure, such as the insertion or replacement of a pacemaker. The procedure requires access to the perineal region, and anesthesia services are provided to ensure patient comfort and safety during the intervention. The anesthesia is administered by a provider with a specialty in anesthesiology, cardiovascular disease, or cardiac electrophysiology. The clinical workflow involves preoperative assessment, administration of anesthesia, monitoring throughout the procedure, and postoperative care.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider is present and monitoring the patient, but not providing general anesthesia.
- P1: A normal healthy patient. Indicates the patient's physical status as normal and healthy.
Provider Taxonomies:

Code Specialty
207L00000X

Code	Specialty
`207L00000X`

National Reimbursement Benchmarks

National mean rates for CPT code 00952 show that commercial payers such as Aetna, Blue Cross Blue Shield, and Cigna reimburse at significantly higher levels than UnitedHealth Group and the BUCA average. The BUCA mean rate stands at $162.34, while UnitedHealth Group is notably lower at $65.64. Medicare data is not available in the input for comparison.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Aetna exhibits the widest spread ($406.00 - $46.50 = $359.50), indicating substantial variability in contracted rates. Blue Cross Blue Shield has a tighter range ($299.00 - $167.25 = $131.75), while UnitedHealth Group shows the narrowest dispersion ($75.75 - $50.33 = $25.42), suggesting more consistent rates nationally. The table and chart below present the full breakdown of national benchmarks by payer.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska displays a wide rate spread for CPT code 00952, with Blue Cross Blue Shield showing the largest difference between the 25th and 75th percentiles ($298.75 minus $225.80 = $72.95), indicating substantial variability in reimbursement. In contrast, UnitedHealth Group and Aetna have much narrower spreads, both with a 25th and 75th percentile difference of $4.00 and $24.75 respectively, suggesting more consistent rates among providers. Cigna's spread is also limited at $8.00.

Compared to national averages, Blue Cross Blue Shield's mean rate in Alaska is higher, while Cigna and UnitedHealth Group are notably lower than their national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these differences and the overall distribution across major commercial payers.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00952 in Alaska, with a mean rate of $269.02.
UnitedHealth Group offers the lowest mean rate at $75.12.
Cigna and UnitedHealth Group rates in Alaska are significantly below their respective national averages, while Blue Cross Blue Shield's mean rate is notably above the national benchmark.

Related Codes

00930

CPT 00930: Anesthesia for Orchiopexy, Unilateral or Bilateral

01140

CPT 01140: Anesthesia for Interpelviabdominal (Hindquarter) Amputation

01112

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

00936

CPT 00936: Anesthesia for Perineal Procedures with Lymphadenectomy

00918

CPT 00918: Anesthesia for Stone Removal Procedures

01130

CPT 01130: Anesthesia for Body Cast Procedure

01170

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

00920

CPT 00920: Anesthesia for Male Genital Procedures, NOS

00948

CPT 00948: Anesthesia for Procedures on the Perineum

00908

CPT 00908: Anesthesia for Male Genitalia Procedures, Not Otherwise Specified

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