CPT 00406: Anesthesia for Integumentary and Breast Procedures - OpenPayer

Summary & Overview

CPT 00406: Anesthesia for Integumentary and Breast Procedures

CPT code 00406 denotes anesthesia for surgical procedures involving the integumentary system of the extremities, anterior trunk, and perineum, and specifically covers radical or modified radical breast procedures with internal mammary node dissection. As an anesthesia procedure code, it is central to perioperative billing for a range of dermatologic, soft-tissue, and oncologic breast operations. Nationally, accurate use of this CPT code matters for appropriate anesthesia payment, perioperative documentation, and alignment with surgical procedure coding.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of clinical context for 00406, guidance on common billing considerations tied to the described service type and site of service, and pointers to related procedural codes that commonly intersect with anesthesia billing. The publication highlights where 00406 is typically applied, common clinical scenarios that generate use of the code, and operational implications for hospitals and anesthesia practices. This summary provides a national perspective intended to clarify the code’s scope and situational use without state-level or payer-specific rate discussion.

AetnaBlue Cross Blue ShieldCigna HealthUnited HealthcareMedicareCPT 00406anesthesiaintegumentary systembreast surgeryoperating roomperioperative caresurgical anesthesiaprocedure coding

Billing Code Overview

CPT code 00406 describes anesthesia services provided for procedures on the integumentary system of the extremities, anterior trunk, and perineum, and explicitly includes radical or modified radical procedures on the breast with internal mammary node dissection. The service type is general anesthesia for surgical procedures involving skin, subcutaneous tissue, and related structures in the specified anatomical regions. The typical site of service is an operating room or surgical suite where operative management of integumentary and breast procedures is performed.

Clinical & Coding Specifications

Clinical Context

A 58-year-old female with a diagnosis of malignant neoplasm of the glottis (C32.0) and progressive voice change is scheduled for surgery involving the integumentary system of the anterior trunk and perineum — in this billing context the anesthetic services cover procedures such as radical or modified radical breast surgery with internal mammary node dissection. The patient has a history of prior tracheostomy with a documented complication (J95.02) and intermittent abnormal sputum production (R09.3). Preoperative evaluation is performed by the anesthesiology team (physician or Certified Registered Nurse Anesthetist) to assess airway risk given vocal cord paralysis (J38.00) and congenital laryngomalacia (Q31.5) history. Airway planning may include awake fiberoptic intubation or planned tracheostomy support depending on exam and prior surgical history.

On the day of surgery the anesthesia team documents airway management, monitoring, and regional or general anesthetic techniques appropriate for breast and adjacent integumentary procedures. Intraoperative management includes standard ASA monitors, possible invasive monitoring for complex resections, and coordination with surgical oncology for lymph node dissection. Postoperative handoff includes disposition to PACU or ICU with notes on airway status, analgesic plan, and any tracheostomy-related issues.

Coding Specifications

Modifier and taxonomy selections below reflect modifiers most clinically relevant to anesthesia for integumentary/extremity/anterior trunk/perineum procedures including breast procedures with internal mammary node dissection.

CPT 00625: Anesthesia for Thoracic Spine Procedure, Anterior Transthoracic

00640

CPT 00640: Anesthesia for Spine and Spinal Cord Procedures

00522

CPT 00522: Anesthesia for Needle Biopsy of Pleura, Closed Chest Procedure

cpt-00546-anesthesia-open-lung-resection-thoracic-repair

CPT 00546: Anesthesia for Open Lung Resection and Thoracic Repair

00580

CPT 00580: Anesthesia for Heart and Lung Transplant

00563

CPT 00563: Anesthesia for Heart Procedures with Pump

00634

CPT 00634: Anesthesia for Thoracic Spine and Cord Procedures

cpt-00410-anesthesia-integumentary-procedures-electrical-cardioversion

CPT 00410: Anesthesia for Integumentary Procedures with Electrical Cardioversion

00520

CPT 00520: Anesthesia for Closed Chest Procedures Including Bronchoscopy

cpt-00402-anesthesia-integumentary-extremities-trunk-perineum-breast-reconstruct

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

Showing 1–10 of 85

Taxonomy Code	Specialty	Notes
`207L00000X`	Anesthesiology	Physician anesthesiologists providing perioperative anesthesia and airway management.
`367500000X`	Certified Registered Nurse Anesthetist	CRNAs providing anesthesia services under appropriate supervision or independently per state/payer rules.
`207LA0401X`	Pain Medicine (Anesthesiology)	Anesthesiology subspecialists who may be involved in perioperative analgesia or complex pain management for oncologic procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C32.0`	Malignant neoplasm of glottis	Primary oncologic airway pathology impacting airway management and need for specialized anesthetic planning.
`J38.00`	Paralysis of vocal cords and larynx, unspecified	Vocal cord paralysis increases aspiration and airway difficulty risk; affects intubation strategy.
`J95.02`	Tracheostomy complication	Prior tracheostomy complications can alter airway anatomy and perioperative airway risk and require coordination with surgical teams.
`Q31.5`	Congenital laryngomalacia	Structural airway abnormality influencing airway stability under sedation or anesthesia.
`R09.3`	Abnormal sputum	Reflects airway secretion issues that can increase aspiration risk and influence perioperative pulmonary management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31500`	Intubation, endotracheal, emergency procedure	May be performed emergently for airway compromise in patients with vocal cord paralysis or tracheostomy complications prior to or during anesthesia.
`31575`	Laryngoscopy, flexible; diagnostic	Used for airway assessment (flexible laryngoscopy) in preoperative evaluation of patients with glottic pathology or vocal cord dysfunction.
`31600`	Tracheostomy, planned (separate procedure)	Performed when long-term airway management is required or when airway anatomy precludes safe prolonged intubation; relevant given tracheostomy complication history.
`60240`	Thyroidectomy, total or complete	May be performed in the same oncologic care pathway for head and neck malignancies; anesthesia planning considerations overlap for airway and neck surgery.

`22`	Increased procedural services	Use when anesthesia or perioperative work is substantially greater due to complexity or comorbidity and documentation supports increased effort.
`23`	Unusual anesthesia	Use when general anesthesia is administered for a procedure that normally would not require it and documentation supports medical necessity.
`50`	Bilateral procedure	Use when bilateral surgical procedures are performed and anesthesia time/effort applies to both sides.
`52`	Reduced services	Use when the anesthesia service was partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the anesthesia service was discontinued due to patient instability or other documented reason prior to completion.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons; may affect anesthesia planning for complex oncologic resections.
`78`	Unplanned return to OR	Use for anesthesia services provided when patient returns to the operating room for a related procedure during the global period.
`AA`	Anesthesia by anesthesiologist	Use to indicate the anesthesia service was personally performed by an MD/DO anesthesiologist.
`AD`	Medical direction by anesthesiologist	Use when an anesthesiologist medically directs CRNAs and meets supervision requirements.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for anesthesiology	Use when qualifying non-physician anesthesia providers perform or assist under appropriate rules (varies by payer).
`QK`	Medical direction of two to four CRNAs by an anesthesiologist	Use when the anesthesiologist directs multiple CRNAs and meets CMS requirements for medical direction.
`QS`	Monitored anesthesia care (MAC) service	Use when MAC is provided and a specific modifier is required by payer reporting guidelines.
`QX`	CRNA service: CRNA with medical direction by a physician	Use to identify services performed by a CRNA when a physician is involved in direction.

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