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    OpenPayerBilling CodesAnesthesia for Procedures on the Thorax (Chest Wall and Shoulder Girdle)CPT cpt-00404-anesthesia-integumentary-extremities-trunk-perineum-breast
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    CPT 00404: Anesthesia for Integumentary Procedures on Extremities/Trunk/Perineum

    Commercial payers pay $82 on average nationally for this procedure.

    CPT code 00404 describes anesthesia services provided for procedures on the integumentary system of the extremities, anterior trunk, and perineum, and includes anesthesia for radical or modified radical breast procedures; the service type is anesthesia for surgical procedures and the typical site of service is an operating room or procedural suite where dermatologic, plastic, or breast surgery is 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.

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    National Reimbursement Benchmarks

    National commercial rates for CPT 00404 center around BUCA’s average commercial rate of $81.70, with notable variation among major carriers. Blue Cross Blue Shield has a moderate median at $63.80 while Aetna’s distribution is the most dispersed, stretching to a high $555.60 and a median of $57.00; UnitedHealth Group and Cigna sit closer to BUCA, with medians of $64.00 and $87.00 respectively. These medians suggest BUCA’s average lies near the middle of the payer mix rather than at an extreme.

    Examining interquartile dispersion (P75 minus P25) highlights which payers are tightest or widest: Blue Cross Blue Shield’s IQR is $37.30, UnitedHealth Group’s IQR is $30.90, Cigna’s IQR is $55.70, and Aetna’s IQR is $72.40, making Aetna the widest and UnitedHealth Group the tightest among those with listed quartiles. BUCA’s quartiles imply an IQR of $46.70, placing it between the narrowest and widest payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 52-year-old female with a history of right-sided lobular carcinoma in situ (D05.11) and prior mastectomy presenting for immediate breast reconstruction following mastectomy (Z42.1). Preoperative assessment documents general anesthesia risk P2 due to well-controlled hypertension. The anesthesia team provides perioperative management for a modified radical mastectomy with immediate reconstruction on the anterior trunk and breast, consistent with anesthesia code 00404. The workflow begins with a preoperative anesthesia evaluation, documentation of informed consent for anesthesia, intraoperative general endotracheal anesthesia with appropriate monitoring and regional blocks as indicated, and postoperative handoff to PACU with documented anesthetic duration, medications administered, fluids, estimated blood loss, and any intraoperative events such as a difficult airway or significant hemorrhage. Billing and coding capture the base anesthesia code 00404 with applicable modifiers for concurrent circumstances (for example, bilateral procedure, professional component, or unusual anesthesia complexity) and the primary ICD-10 diagnosis code reflecting the malignant or reconstructive breast condition. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for verification of coverage and preauthorization requirements prior to surgery.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    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…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207N00000X
    208200000X
    163WX1100X
    207NI0002X
    207V00000X
    246Q00000X
    222Z00000X

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    C50.111Malignant neoplasm of central portion of right female breast
    C50.112Malignant neoplasm of central portion of left female breast
    C50.119Malignant neoplasm of central portion of unspecified female breast
    C50.911Malignant neoplasm of unspecified site of right female breast
    C50.912Malignant neoplasm of unspecified site of left female breast
    C50.919Malignant neoplasm of unspecified site of unspecified female breast
    D05.11Intraductal carcinoma in situ of right breast
    D23.5Other benign neoplasm of skin of trunk
    D49.2Neoplasm of unspecified behavior of bone, soft tissue, and skin
    E11.621Type 2 diabetes mellitus with foot ulcer

    Showing 1–10 of 29

    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-00400-ANESTHESIA-INTEGUMENTARY-EXTREMITIES-ANTERIOR-TRUNK-PERINEUM

    CPT 00400: Anesthesia for Integumentary Procedures on Extremities/Trunk/Perineum

    CPT-00402-ANESTHESIA-INTEGUMENTARY-EXTREMITIES-TRUNK-PERINEUM-BREAST-RECONSTRUCT

    CPT 00402: Anesthesia for Integumentary Procedures on Extremities/Trunk/Perineum

    CPT-00406-ANESTHESIA-INTEGUMENTARY-EXTREMITIES-ANTERIOR-TRUNK-PERINEUM

    CPT 00406: Anesthesia for Integumentary and Breast Procedures

    CPT-00410-ANESTHESIA-INTEGUMENTARY-PROCEDURES-ELECTRICAL-CARDIOVERSION

    CPT 00410: Anesthesia for Integumentary Procedures with Cardiac Electrical Conversion

    CPT-00450-ANESTHESIA-CLAVICLE-SCAPULA-PROCEDURE

    CPT 00450: Anesthesia for Clavicle and Scapula Procedures

    CPT-00454-CLAVICLE-BIOPSY-ANESTHESIA

    CPT 00454: Anesthesia for Clavicle Biopsy

    CPT-00470-PARTIAL-RIB-REMOVAL-ANESTHESIA

    CPT 00470: Anesthesia for Partial Rib Removal

    CPT-00472-PARTIAL-RIB-RESECTION-THORACOPLASTY-ANESTHESIA

    CPT 00472: Anesthesia for Partial Rib Resection with Thoracoplasty

    CPT-00474-ANESTHESIA-PARTIAL-RIB-RESECTION-THORACIC

    CPT 00474: Anesthesia for Partial Rib Resection

    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.
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    00404Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breastPrimary anesthesia code describing services for modified radical mastectomy and related breast procedures on the anterior trunk.