Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesAnesthesia for Procedures on the HeadCPT cpt-00170-anesthesia-intraoral-procedure-biopsy
    Ask Trek AI about this page

    CPT 00170: Anesthesia for Intraoral Procedure, Including Biopsy

    Commercial payers pay $87 on average nationally for this procedure.

    CPT code 00170 describes anesthesia services provided for a patient undergoing an intraoral procedure, such as a biopsy; this represents anesthesia care (general or monitored anesthesia care as clinically appropriate) delivered in an oral surgery or dental operative setting, typically an operating room, ambulatory surgery center, or procedure suite where intraoral surgical interventions are performed.

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

    Customize your policy alerts

    Sign up for cpt 00170 policy alerts

    Get alerted when payer policies referencing 00170 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    National Reimbursement Benchmarks

    National commercial reimbursement for CPT 00170 centers on BUCA’s average commercial benchmark of $86.80, with variation among large payers. Aetna’s mean of $140.30 sits well above BUCA, while Cigna’s mean of $96.50 and UnitedHealth Group’s mean of $67.60 bracket BUCA on either side; Blue Cross Blue Shield’s mean of $72.20 is just below BUCA. This frames BUCA as a mid-market reference point, with Aetna notably higher and UnitedHealth Group and Blue Cross Blue Shield toward the lower end of the commercial spectrum.

    Dispersion measured by the interquartile difference (P75 minus P25) highlights where rates are most and least concentrated. Aetna’s IQR is $100.50 ($181.80 - $83.30), the widest among the set, followed by Cigna at $58.60 ($125.00 - $68.40). Blue Cross Blue Shield and UnitedHealth Group show tighter spreads of $41.20 ($93.40 - $52.00) and $29.10 ($81.10 - $52.00) respectively, indicating more consistent contracted ranges across those payers.

    Table of contents

    Progress1 / 8

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 52-year-old patient presents to an oral and maxillofacial surgery clinic with a painful, enlarging ulcerative lesion on the lateral tongue and intermittent salivary gland swelling. The surgeon schedules an intraoral biopsy and possible minor excision under general anesthesia because of anticipated patient anxiety, gag reflex, and the need for an immobile surgical field. Preoperative evaluation by the anesthesia team documents American Society of Anesthesiologists (ASA) physical status P2 for controlled hypertension. On the day of surgery the anesthesiologist administers general anesthesia with airway management appropriate for an intraoral procedure, provides intraoperative monitoring, and directs emergence and immediate postoperative care in the PACU. The surgical procedure includes an intraoral biopsy of the lesion with hemostasis and limited soft tissue repair.

    Typical workflow:

    • Preoperative assessment and anesthesia consent completed by an Anesthesiologist (207L00000X) or Anesthesiology Assistant (207LA0401X) under supervision.

    • Perioperative monitoring and induction of general anesthesia in the operating room; adjunct airway devices used as needed for intraoral access.

    • Surgeon performs intraoral biopsy and limited repair; anesthesiologist documents anesthesia time, clinical events, and any services warranting modifier application.

    • Immediate postoperative recovery in PACU with anesthesia handover and documentation of any complications that may require modifier reporting (for example unexpected anesthesia difficulty or additional services).

    Related CPT Codes

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207LA0401X
    207LC0200X
    376K00000X
    335E00000X
    261QR0208X
    251K00000X
    163W00000X

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

    CPT-00100-ANESTHESIA-FOR-SALIVARY-GLAND-PROCEDURES

    CPT 00100: Anesthesia for Salivary Gland Procedures

    CPT-00102-ANESTHESIA-CLEFT-LIP-REPAIR

    CPT 00102: Anesthesia for Plastic Repair of Cleft Lip

    CPT-00103-ANESTHESIA-RECONSTRUCTIVE-EYELID-SURGERY

    CPT 00103: Anesthesia for Reconstructive Eyelid Procedures

    CPT-00104-ANESTHESIA-FOR-ELECTROCONVULSIVE-THERAPY

    CPT 00104: Anesthesia for Electroconvulsive Therapy

    CPT-00120-ANESTHESIA-FOR-EAR-PROCEDURES

    CPT 00120: Anesthesia for External, Middle, and Inner Ear Procedures

    CPT-00124-ANESTHESIA-EXTERNAL-MIDDLE-INNER-EAR-BIOPSY-OTOSCOPY

    CPT 00124: Anesthesia for External, Middle, and Inner Ear Procedures

    CPT-00126-ANESTHESIA-FOR-OTOLOGIC-PROCEDURES-TYMPANOTOMY-BIOPSY

    CPT 00126: Anesthesia for External, Middle, and Inner Ear Procedures

    CPT-00140-ANESTHESIA-FOR-EYE-PROCEDURE-OPHTHALMIC-SURGERY

    CPT 00140: Anesthesia for Eye Procedure

    CPT-00142-ANESTHESIA-FOR-EYE-LENS-PROCEDURE

    CPT 00142: Anesthesia for Eye Lens Procedure

    CPT-00144-ANESTHESIA-CORNEAL-TRANSPLANT

    CPT 00144: Anesthesia for Corneal Transplant

    Showing 1–10 of 30

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    CPT CodeDescriptionRelationship to This Procedure
    00172ANES INTRAORAL PX W/BIOPSY REPAIR CLEFT PALATEUsed when anesthesia services are provided for intraoral biopsy and repair specifically related to cleft palate surgery; more specialized anatomic context compared with 00170.

    00174 | ANES INTRAORAL PX W/BX EXC RETROPHARYNGEAL TUMOR | Indicates anesthesia for intraoral biopsy and excision of deeper retropharyngeal masses; typically involves more complex airway management and longer anesthesia time.

    00176 | ANESTHESIA INTRAORAL PX W/BIOPSY RADICAL SURGERY | Used when anesthesia is provided for radical intraoral surgery with biopsy, reflecting higher complexity and resource utilization compared with a routine intraoral biopsy under 00170.