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CPT 00164: Anesthesia for Soft Tissue Biopsy of Nose and Accessory Sinuses
CPT code 00164 represents anesthesia services delivered for a soft tissue biopsy of the nose and accessory sinuses. This code captures perioperative anesthesia care specific to biopsy procedures on nasal and paranasal sinus soft tissues and is used in facility and professional billing to denote the anesthesia component of these ENT procedures. Nationally, accurate use of CPT code 00164 ensures appropriate classification of anesthesia services tied to minor head and neck diagnostic procedures and supports consistent claims processing across payers.
Key payers covered in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an outline of clinical context for nasal and sinus biopsy anesthesia, typical sites of service, and how CPT code 00164 relates to nearby anesthesia codes for nose and accessory sinus procedures. The publication presents payer coverage considerations and common billing modifiers used with anesthesia codes to reflect unusual circumstances, bilateral procedures, and splits of professional responsibilities. Related anesthesia codes for nose and accessory sinus procedures are noted for coding alignment.
This summary is intended to inform coding, billing, and revenue cycle staff, as well as clinicians and administrators, about the clinical scope and billing context for CPT code 00164 and where it fits among anesthesia services for nasal and sinus procedures.
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Billing Code Overview
CPT code 00164 describes anesthesia services provided for a soft tissue biopsy of the nose and accessory sinuses. The service involves administration and management of anesthesia to enable surgical biopsy of nasal and paranasal sinus soft tissues.
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Service type: Anesthesia for soft tissue biopsy of the nose and accessory sinuses
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Typical site of service: Operating room or procedure suite where ENT procedures, including nasal and sinus biopsies, are performed
National Reimbursement Benchmarks
National commercial rates for CPT 00164 cluster around BUCA’s average commercial rate of $74.90, with notable variation among individual payers. Cigna shows the highest central tendency (median $84.40) and a strong upper tail (P90 $142.50), while Blue Cross Blue Shield has both a high maximum ($216.10) and a relatively elevated P90 ($128.00). Aetna and UnitedHealth Group sit lower on central measures, with Aetna’s median at $48.00 and UnitedHealth Group’s median at $64.20, illustrating a spread of contracting outcomes across major commercial carriers.
Assessing dispersion via the interquartile range (P75 minus P25) highlights where rates are most and least consistent. Blue Cross Blue Shield has the widest IQR at $48.00 (P75 $96.00 minus P25 $54.20), followed by Cigna at $40.40 (P75 $108.10 minus P25 $67.60). UnitedHealth Group’s IQR is $29.10, and Aetna’s IQR is $38.00, indicating comparatively tighter clustering for UnitedHealth Group and the widest variability for Blue Cross Blue Shield and Cigna around their mid‑distribution values.