CPT 00172: Anesthesia for Intraoral Procedure, Cleft Palate Repair

CPT code 00172 designates anesthesia services for intraoral procedures including biopsy and cleft palate repair. This code is used to capture the anesthesiologist’s or anesthesia professional’s services during oral cavity operations that commonly occur in operating rooms or ambulatory surgical centers. Nationally, accurate reporting of this code supports appropriate payment for perioperative anesthesia care and informs utilization patterns for head and neck surgical services. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise explanation of the clinical context for the code, how it aligns with similar anesthesia codes for oral and pharyngeal procedures, and the typical sites of service where it applies. The publication also summarizes payer coverage considerations and common coding relationships to neighboring anesthesia codes for mouth and pharyngeal procedures. The content is intended to clarify code intent, support correct claim submission, and provide a national perspective on where this code fits within anesthesia billing for intraoral and cleft palate surgeries. Data not available in the input for detailed payer-specific reimbursement benchmarks and audit patterns.

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Billing Code Overview

CPT code 00172 describes anesthesia services provided for an intraoral surgical procedure, specifically including biopsy and repair of a cleft palate. The service type is anesthesia for intraoral surgery, and the typical site of service is an operating room or ambulatory surgical center where oral and maxillofacial procedures are performed. This code indicates the anesthesiologist or anesthesia professional administered and managed anesthesia care for a patient undergoing procedures involving the oral cavity and cleft palate repair.

National Reimbursement Benchmarks

National commercial rates for CPT 00172 cluster around BUCA’s average commercial rate of $76.80, with important variation by insurer. Blue Cross Blue Shield (BCBS) shows a moderate center with a median of $62.50, while Cigna and Aetna sit higher in central tendency with medians of $81.00 and $57.00 respectively; UnitedHealth Group’s median is $64.00. Cigna’s mean of $87.70 and Aetna’s mean of $94.90 pull their averages upward, whereas BCBS and UnitedHealth Group have lower means, reflecting insurer-level pricing differences around the BUCA average.

Dispersion measured as P75 minus P25 highlights where rates are tightest and widest: BCBS has the tightest interquartile spread at $40.60 ($91.80 - $51.20), while Aetna is the widest at $69.00 ($113.30 - $44.30). UnitedHealth Group’s spread is $29.00 ($81.00 - $52.00), Cigna’s is $37.80 ($103.30 - $65.50), and BUCA’s interquartile spread is $41.10 ($95.50 - $52.40). These ranges indicate Aetna and BUCA encompass broader mid‑to‑upper commercial rate variability compared with BCBS and UnitedHealth Group.

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CPT 00172: Anesthesia for Intraoral Procedure, Cleft Palate Repair

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Billing Code Overview

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 6-year-old child with a congenital cleft palate presents for intraoral repair and simultaneous biopsy of a small suspicious intraoral lesion. Preoperative evaluation in the ambulatory surgical center includes assessment by the anesthesiology team due to airway concerns associated with the cleft and prior history of mild reactive airway disease. On the day of surgery the patient undergoes preinduction monitoring, intravenous induction with appropriate pediatric dosing, placement of a secure airway (oral endotracheal tube) with careful attention to mask ventilation and direct laryngoscopy given altered anatomy, intraoperative maintenance of general anesthesia with neuromuscular blockade for surgical exposure, and postoperative extubation in the recovery area after adequate reversal and airway protective reflexes return. The anesthesia service documented start and stop times for billing, perioperative airway management, intraoperative fluids and medications, and any intraoperative complications such as significant blood loss or hemodynamic instability. Postoperative monitoring includes pain control, nausea prophylaxis, and disposition to home with instructions to caregivers. This workflow is typical for anesthesia for intraoral procedures including biopsy and cleft palate repair.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when anesthesia care requires substantially greater work due to unusual circumstances beyond the typical complexity of the case.
`23`	Unusual anesthesia	Use when general anesthesia is administered but typically not required for the procedure, or a higher level of anesthesia than usual is needed.
`50`	Bilateral procedure	Use when identical procedures are performed on both sides of the mouth requiring bilateral anesthesia considerations.
`52`	Reduced services	Use when the anesthesia service is partially reduced or abbreviated, e.g., case terminated early.
`53`	Discontinued procedure	Use when anesthesia is discontinued because the procedure was terminated for patient safety reasons.
`62`	Two surgeons	Use when two surgeons are required concurrently for surgical repair and documentation supports split surgical responsibility affecting anesthesia planning.
`78`	Unplanned return to OR following initial anesthesia	Use when the patient returns to the operating room for a related procedure requiring additional anesthesia within the global period.
`AA`	Anesthesia by physician	Use to indicate the anesthesiologist personally performed the anesthesia service.
`QK`	Medical direction of two or more CRNAs/AA by a physician	Use when one anesthesiologist medically directs multiple CRNAs or AAs during the case.
`QS`	Monitored anesthesia care service	Use when the service rendered is monitored anesthesia care rather than general anesthesia, if clinically applicable.
`QX`	CRNA service with medical direction by physician	Use when a CRNA provides anesthesia under medical direction of a physician.
`QY`	Medical direction of one CRNA/AA by a physician	Use when the anesthesiologist medically directs one CRNA or AA.
`AD`	Medical supervision by a physician: more than four concurrent anesthesia cases	Use when the physician supervises multiple concurrent anesthesia providers as defined by payer policy.

Taxonomy Code	Specialty	Notes
`207L00000X`	Anesthesiology	Physician anesthesiologists performing or supervising anesthesia care for intraoral and cleft palate procedures.
`207LA0401X`	Anesthesiology Assistant	Anesthesiology assistants providing services under physician supervision depending on state and payer rules.
`367500000X`	Certified Registered Nurse Anesthetist	CRNAs who may provide anesthesia services independently or under physician direction per payer and state regulations.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H25.9`	Unspecified age-related cataract	Although an ocular diagnosis, listed codes reflect input set; not directly related to intraoral anesthetic but may appear in the patient problem list affecting perioperative assessment if concurrent ophthalmologic disease exists.
`H26.9`	Unspecified cataract	As above, may be present in the medical history and influence overall perioperative risk assessment.
`H27.9`	Unspecified disorder of lens	Listed as a comorbid ophthalmologic condition in the patient record; relevant to comprehensive preoperative evaluation.
`H28`	Cataract in diseases classified elsewhere	Reflects cataract associated with systemic or other ocular disease; may be part of the medical history considered during anesthesia planning.
`H52.4`	Presbyopia	Common refractive disorder noted in adult patient history; included in the problem list and not directly related to intraoral anesthesia but relevant to overall documentation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`00170`	Anesthesia for procedures on the mouth (not otherwise specified)	Alternate anesthesia code used for other intraoral procedures; may be selected when the procedure falls under a different mouth surgery classification.
`00174`	Anesthesia for pharyngeal surgery	Used when the surgical field extends to the pharynx or when combined procedures include pharyngeal surgery requiring anesthesia coverage.
`00176`	Anesthesia for pharyngeal surgery	Related code for more extensive or different pharyngeal procedures; used when clinical documentation indicates pharyngeal surgical intervention in addition to intraoral work.

CPT 00100: Anesthesia for Salivary Gland Procedures, Including Biopsy

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 Surgery

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 Ear Procedures, Including Tympanotomy and Biopsy

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

CPT 00140: Anesthesia for Eye Procedure, Ophthalmic Surgery

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

CPT 00142: Anesthesia for Eye Lens Procedure

CPT-00144-ANESTHESIA-CORNEAL-TRANSPLANT

CPT 00144: Anesthesia for Corneal Transplantation

Showing 1–10 of 30

References

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.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.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.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when anesthesia care requires substantially greater work due to unusual circumstances beyond the typical complexity of the case.
`23`	Unusual anesthesia	Use when general anesthesia is administered but typically not required for the procedure, or a higher level of anesthesia than usual is needed.
`50`	Bilateral procedure	Use when identical procedures are performed on both sides of the mouth requiring bilateral anesthesia considerations.
`52`	Reduced services	Use when the anesthesia service is partially reduced or abbreviated, e.g., case terminated early.
`53`	Discontinued procedure	Use when anesthesia is discontinued because the procedure was terminated for patient safety reasons.
`62`	Two surgeons	Use when two surgeons are required concurrently for surgical repair and documentation supports split surgical responsibility affecting anesthesia planning.
`78`	Unplanned return to OR following initial anesthesia	Use when the patient returns to the operating room for a related procedure requiring additional anesthesia within the global period.
`AA`	Anesthesia by physician	Use to indicate the anesthesiologist personally performed the anesthesia service.
`QK`	Medical direction of two or more CRNAs/AA by a physician	Use when one anesthesiologist medically directs multiple CRNAs or AAs during the case.
`QS`	Monitored anesthesia care service	Use when the service rendered is monitored anesthesia care rather than general anesthesia, if clinically applicable.
`QX`	CRNA service with medical direction by physician	Use when a CRNA provides anesthesia under medical direction of a physician.
`QY`	Medical direction of one CRNA/AA by a physician	Use when the anesthesiologist medically directs one CRNA or AA.
`AD`	Medical supervision by a physician: more than four concurrent anesthesia cases	Use when the physician supervises multiple concurrent anesthesia providers as defined by payer policy.

Taxonomy Code	Specialty	Notes
`207L00000X`	Anesthesiology	Physician anesthesiologists performing or supervising anesthesia care for intraoral and cleft palate procedures.
`207LA0401X`	Anesthesiology Assistant	Anesthesiology assistants providing services under physician supervision depending on state and payer rules.
`367500000X`	Certified Registered Nurse Anesthetist	CRNAs who may provide anesthesia services independently or under physician direction per payer and state regulations.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H25.9`	Unspecified age-related cataract	Although an ocular diagnosis, listed codes reflect input set; not directly related to intraoral anesthetic but may appear in the patient problem list affecting perioperative assessment if concurrent ophthalmologic disease exists.
`H26.9`	Unspecified cataract	As above, may be present in the medical history and influence overall perioperative risk assessment.
`H27.9`	Unspecified disorder of lens	Listed as a comorbid ophthalmologic condition in the patient record; relevant to comprehensive preoperative evaluation.
`H28`	Cataract in diseases classified elsewhere	Reflects cataract associated with systemic or other ocular disease; may be part of the medical history considered during anesthesia planning.
`H52.4`	Presbyopia	Common refractive disorder noted in adult patient history; included in the problem list and not directly related to intraoral anesthesia but relevant to overall documentation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`00170`	Anesthesia for procedures on the mouth (not otherwise specified)	Alternate anesthesia code used for other intraoral procedures; may be selected when the procedure falls under a different mouth surgery classification.
`00174`	Anesthesia for pharyngeal surgery	Used when the surgical field extends to the pharynx or when combined procedures include pharyngeal surgery requiring anesthesia coverage.
`00176`	Anesthesia for pharyngeal surgery	Related code for more extensive or different pharyngeal procedures; used when clinical documentation indicates pharyngeal surgical intervention in addition to intraoral work.

CPT 00100: Anesthesia for Salivary Gland Procedures, Including Biopsy

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 Surgery

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 Ear Procedures, Including Tympanotomy and Biopsy

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

CPT 00140: Anesthesia for Eye Procedure, Ophthalmic Surgery

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

CPT 00142: Anesthesia for Eye Lens Procedure

CPT-00144-ANESTHESIA-CORNEAL-TRANSPLANT

CPT 00144: Anesthesia for Corneal Transplantation

Showing 1–10 of 30

References

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.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.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.

OpenPayer

CPT 00172: Anesthesia for Intraoral Procedure, Cleft Palate Repair

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Billing Code Overview

National Reimbursement Benchmarks

OpenPayer

CPT 00172: Anesthesia for Intraoral Procedure, Cleft Palate Repair

Sign up for cpt 00172 policy alerts

Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References