Find policies, billing codes, payers, states, and providers
CPT 00635: Anesthesia for Lumbar Region Procedure with Lumbar Puncture
CPT code 00635 identifies anesthesia services rendered for procedures involving the lumbar region when a diagnostic or therapeutic lumbar puncture is performed. This code captures anesthetic management specific to spinal access in the lumbar area and is used by anesthesia professionals billing for peri-procedural care. Nationally, accurate use of this code supports appropriate payment for anesthesia resources and reflects the complexity and location-specific risks of lumbar spinal procedures.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of clinical context for lumbar-region anesthesia, common associated diagnoses, and how this code relates to adjacent anesthesia codes for spine procedures. The publication presents benchmarks and policy-relevant points for coding consistency and claims processing, highlights common clinical scenarios that map to this code, and discusses related anesthesia code relationships used in spinal interventions.
This summary provides clinicians, coders, and payers with a concise reference to the purpose of 00635, its role in billing for lumbar puncture anesthesia, and the types of situations in which it is applicable. Data not available in the input is noted where relevant.
Customize your policy alerts
Sign up for cpt 00635 policy alerts
Get alerted when payer policies referencing 00635 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 00635 describes anesthesia services provided for procedures in the lumbar region, specifically when the anesthetic care includes a diagnostic or therapeutic lumbar puncture. The service type is anesthesia for lumbar-region procedures that involve spinal access for diagnostic or treatment purposes. The typical site of service is an operating room, procedure suite, or other controlled clinical setting where lumbar punctures and related spinal procedures are performed.
National Reimbursement Benchmarks
Commercial reimbursement for CPT 00635 clusters around BUCA’s average commercial rate of $83.3, with individual payers showing meaningful differences in central tendency and spread. Aetna and Cigna sit above BUCA on mean and median values (Aetna mean $113.6, median $93.8; Cigna mean $91.4, median $84.4), while Blue Cross Blue Shield’s mean ($75.7) and UnitedHealth Group’s mean ($67.9) fall below BUCA’s average. Minimums and maximums amplify Aetna’s higher ceiling ($314.1 max) and Blue Cross Blue Shield’s lower floor ($3.3 min), highlighting asymmetry across the market.
Dispersion measured by the interquartile spread (P75–P25) is widest for Aetna at $101.0 (P75 $156.2 minus P25 $51.2), followed by Cigna at $41.5 (P75 $108.1 minus P25 $67.6). Blue Cross Blue Shield shows a moderate IQR of $39.4 (P75 $94.9 minus P25 $54.9), BUCA’s IQR is $44.9 (P75 $105.0 minus P25 $56.1), and UnitedHealth Group is the tightest at $30.9 (P75 $81.1 minus P25 $52.0), indicating the most consistent commercial rates among the listed payers.