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    v1.0.28
    OpenPayerBilling CodesAnesthesia for Intrathoracic ProceduresCPT cpt-00542-thoracotomy-decortication-anesthesia
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    CPT 00542: Anesthesia for Thoracotomy with Pulmonary Decortication

    Commercial payers pay $69 on average nationally for this procedure.

    CPT code 00542 describes anesthesia services provided for a thoracotomy procedure involving chest wall opening and pulmonary decortication; service type: general anesthesia for thoracic surgery; typical site of service: inpatient operating room or specialized surgical suite for thoracic procedures.

    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 reimbursement for CPT 00542 centers near the BUCA average commercial rate of $69.30, with notable variation among major payers. Cigna sits well above that average with a mean of $92.70 and a high-end concentration (P75 $121.60), while UnitedHealth Group and Aetna cluster closer to BUCA with means of $67.30 and $67.20 respectively. Blue Cross Blue Shield’s mean of $62.90 is slightly below BUCA. These figures frame BUCA as a mid-market reference point for commercial performance.

    Dispersion measured by the interquartile range (P75 minus P25) is tightest for Aetna and Blue Cross Blue Shield at $49.30 (Aetna: $83.30–$42.00) and $45.60 (BCBS: $83.40–$43.80) respectively, indicating more consistency in contracted rates. UnitedHealth Group’s IQR is $28.80, even tighter, while Cigna shows the widest spread at $54.40, reflecting greater variability toward higher reimbursements. BUCA’s IQR is $40.40, placing it between the tighter UnitedHealth Group and the wider Cigna distribution.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 6-year-old child with congenital cardiac anomalies is scheduled for open thoracotomy with decortication of the pleural space to treat an organized empyema causing restrictive lung mechanics. The patient has a history of ventricular septal defect (Q21.0) and mild coarctation of the aorta (Q25.1), with preoperative evaluation by pediatrics and pediatric cardiology. The care team includes a pediatric anesthesiologist with pediatric critical care backup.

    Preoperative workflow includes focused airway and cardiovascular assessment, review of recent echocardiogram and labs, optimization of volume status and coagulation, and discussion of anesthetic plan with the surgeon. Intraoperative management comprises general endotracheal anesthesia, invasive arterial monitoring, possible central venous access, ventilatory strategies to protect a single-lung ventilation if required, and active analgesia including regional techniques if indicated. Postoperative plan includes transfer to pediatric critical care for ventilatory support, hemodynamic monitoring, chest tube management, and pain control. Documentation must state that anesthesia services were provided for thoracotomy with decortication and include preoperative evaluation, intraoperative anesthetic record, airway management, monitoring modalities, fluid and blood product administration, and postoperative disposition.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    7 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…
    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…
    207LA0401XAddiction Medicine (Anesthesiology) PhysicianAn anesthesiologist who specializes in the diagnosis and treatment of addictions.
    2080P0203XPediatric Critical Care Medicine PhysicianA pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the criti…
    163WX0003XInpatient Obstetric Registered NurseNursing Service Providers · Registered Nurse
    2278E1000XEducational Certified Respiratory TherapistThe focus of patient and family education activities is to promote knowledge of disease process, medical therapy, and self help. Respiratory therapis…
    2279P1005XPulmonary Rehabilitation Registered Respiratory TherapistThe respiratory therapist can assist the chronic pulmonary patient in returning to an optimal role in society by providing an effective program. It i…
    171R00000XInterpreterAn Interpreter is a person who translates oral communication between two or more people. This includes translating from one language to another or in…
    225XP0019XPhysical Rehabilitation Occupational TherapistOccupational therapists are experts at helping people lead as independent a life as possible. Occupational therapists bring an understanding of the p…

    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-00528-ANESTHESIA-MEDIASTINOSCOPY-DIAGNOSTIC-THORACOSCOPY

    CPT 00528: Anesthesia for Mediastinoscopy and Diagnostic Thoracoscopy

    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

    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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    00540
    ANESTHESIA THORACOTOMY PROCEDURES NOS
    General anesthesia code for thoracotomy procedures not otherwise specified; alternative when specific lung ventilation is not used.
    00541ANESTHESIA THORACOTOMY PX W/1 LUNG VNTJUse when one-lung ventilation is required during thoracotomy; may be reported when lung isolation is performed.
    00546ANES THORACOTOMY PX PULMONARY RESCJ W/THORACOPRelated when pulmonary resection with thoracotomy is performed in conjunction with decortication or if resection occurs during the same anesthetic.
    00548ANES THORACOTOMY PX NTRATHRC PX TRACHEA&BRONCHIRelated when intrathoracic procedures involving trachea or bronchi occur during the same operative session as decortication.