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    v1.0.28
    OpenPayerBilling CodesAnesthesia for Intrathoracic ProceduresCPT cpt-00528-anesthesia-mediastinoscopy-diagnostic-thoracoscopy
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    CPT 00528: Anesthesia for Mediastinoscopy and Diagnostic Thoracoscopy

    Commercial payers pay $73 on average nationally for this procedure.

    CPT code 00528 describes anesthesia services provided for a patient undergoing mediastinoscopy with possible diagnostic thoracoscopy, a closed-chest procedure in which a surgeon inserts a video camera via an opening at the base of the neck to view structures in the upper chest and may also insert a thoracoscopic camera through the lower chest to inspect the pleura; this represents an anesthesia service for closed chest diagnostic procedures typically performed in an operating room or specialty procedure suite requiring airway and ventilation management.

    For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.

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    National Reimbursement Benchmarks

    National commercial pricing for CPT 00528 centers around the BUCA average of $73.30, with individual payers showing distinct positions: Cigna averages higher at $93.70 while Aetna, Blue Cross Blue Shield, and UnitedHealth Group cluster in the high-$60s to low-$70s range (Aetna $69.50, BCBS $69.80, UnitedHealth Group $67.30). Cigna and Aetna show the highest maximums and minimums respectively, indicating greater top-end and bottom-end variability even as BUCA provides a mid-market reference point.

    Dispersion measured by the interquartile range (P75–P25) highlights where rates are tightest or widest: UnitedHealth Group is the tightest with an IQR of $28.00 (P75 $80.80 minus P25 $52.00), while Cigna shows the widest spread with an IQR of $52.10 (P75 $119.90 minus P25 $67.80). Blue Cross Blue Shield and BUCA have similar moderate dispersion (BCBS IQR $39.90; BUCA IQR $37.50), and Aetna’s IQR is $45.00, indicating mid-to-high variability across commercial payers.

    National Payer Mean Reimbursement Rates

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    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male with a history of coronary artery disease (I25.10), intermittent angina (I20.9), and paroxysmal atrial fibrillation (I48.91) is scheduled for diagnostic mediastinoscopy to evaluate enlarged mediastinal lymph nodes suspected for malignancy. The patient presents to the preoperative anesthesia clinic for evaluation the day before surgery. Preoperative assessment documents prior myocardial infarction history (I21.9), reduced exercise tolerance, and New York Heart Association Class II symptoms consistent with heart failure (I50.9). The anesthesia team reviews cardiac risk, verifies fasting status, medication management (including anticoagulation and rate control agents), and plans for intraoperative monitoring including arterial line and continuous ECG.

    On the day of surgery the patient is brought to the operating room. General endotracheal anesthesia is induced by the anesthesiology team (taxonomy: 207L00000X) with standard ASA monitoring, invasive arterial monitoring for hemodynamic management, and readiness for one-lung ventilation if the surgeon converts to diagnostic thoracoscopy. The surgical team performs mediastinoscopy via a suprasternal neck incision to visualize upper mediastinal structures; if thoracoscopy is required, the surgeon may place a thoracoscopic port through the lateral chest wall. The anesthesiologist manages ventilation, potential single-lung ventilation, and hemodynamic support given cardiac comorbidities. Postoperative care includes immediate recovery in PACU with cardiac monitoring and disposition decisions based on hemodynamic stability and respiratory function.

    Related CPT Codes

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207RA0000XAdolescent Medicine (Internal Medicine) PhysicianAn internist who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and so…
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    225XN1300XNeurorehabilitation Occupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers · Occupational Therapist
    156FX1202XOptometric TechnicianAn optometric technician assists optometrists by performing duties, including but not limited to, basic eye testing, diagnostic tests, and assistance …
    3418M1120XMilitary or U.S. Coast Guard Air Transport AmbulanceVehicle and staff for patient emergency or non-emergency air transport.
    103TC0700XClinical PsychologistA psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and …
    163WM0102XMaternal Newborn Registered NurseNursing Service Providers · Registered Nurse

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 2

    7 rows

    PolicyPayerEffective Date
    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-00500-ANESTHESIA-ESOPHAGUS-PROCEDURE

    CPT 00500: Anesthesia for Esophageal Procedure

    CPT-00520-ANESTHESIA-CLOSED-CHEST-BRONCHOSCOPY

    CPT 00520: Anesthesia for Closed Chest Procedures, Bronchoscopy

    CPT-00522-NEEDLE-PLEURAL-BIOPSY-ANESTHESIA-CLOSED-CHEST

    CPT 00522: Anesthesia for Pleural Needle Biopsy

    CPT-00524-ANESTHESIA-CLOSED-CHEST-PNEUMOCENTESIS

    CPT 00524: Anesthesia for Closed-Chest Pneumocentesis

    CPT-00529-ANESTHESIA-MEDIASTINOSCOPY-ONE-LUNG-VENTILATION

    CPT 00529: Anesthesia for Mediastinoscopy/Thoracoscopy with One-Lung Ventilation

    CPT-00530-ANESTHESIA-PERMANENT-TRANSVENOUS-PACEMAKER-INSERTION

    CPT 00530: Anesthesia for Permanent Transvenous Pacemaker Insertion

    CPT-00532-ANESTHESIA-FOR-CENTRAL-VENOUS-ACCESS

    CPT 00532: Anesthesia for Central Venous Access

    CPT-00534-ANESTHESIA-FOR-TRANSVENOUS-CARDIOVERTER-DEFIBRILLATOR-INSERTION

    CPT 00534: Anesthesia for Transvenous Cardioverter–Defibrillator Insertion

    CPT-00537-CARDIAC-ELECTROPHYSIOLOGY-ANESTHESIA

    CPT 00537: Anesthesia for Cardiac Electrophysiology Procedures

    CPT-00539-TRACHEOBRONCHIAL-RECONSTRUCTION-ANESTHESIA

    CPT 00539: Anesthesia for Tracheobronchial Reconstruction

    Showing 1–10 of 23

    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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    CPT CodeDescriptionRelationship to This Procedure
    00529Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy utilizing one lung ventilationAlternative anesthesia code when one-lung ventilation is used for diagnostic thoracoscopy; higher complexity for ventilation management.
    00524Anesthesia for closed chest proceduresBroader closed chest anesthesia code applicable to some mediastinal procedures; used when coding specificity requires.
    00540Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm and mediastinum (including surgical thoracoscopy); not otherwise specifiedUsed when procedure escalates to thoracotomy or more extensive thoracic surgery beyond mediastinoscopy/diagnostic thoracoscopy.