CPT 00754: Anesthesia for Omphalocele (Upper Abdominal Hernia Repair)
CPT code 00754 designates anesthesia services for surgical repair of an omphalocele—hernia repair of the upper abdomen where abdominal organs protrude through the umbilical base due to congenital abdominal wall defects. This code is important nationally because it captures perioperative anesthesia care for complex congenital abdominal procedures, often involving neonatal or pediatric anesthesiology expertise and specialized perioperative resources. Accurate use affects clinical documentation, case mix classification, and payment for high-acuity pediatric surgical care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find clinical context for the procedure, typical site-of-service expectations (operating room in inpatient or outpatient surgical facilities), and the role of anesthesia in managing congenital abdominal wall defects. The publication provides benchmarks and coding context relevant to anesthesia services for omphalocele repair, highlights clinical considerations tied to pediatric and specialized anesthesiology taxonomies, and links related surgical codes for cross-reference. It also outlines common modifiers used with anesthesia billing and lists relevant ICD-10 diagnoses associated with upper abdominal and shoulder conditions when present in patient records.
This summary is written for a national audience to inform coding accuracy, billing processes, and administrative oversight tied to anesthesia services for congenital abdominal wall repairs.
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Billing Code Overview
CPT code 00754 describes anesthesia services provided for a patient undergoing hernia repair in the upper abdomen for an omphalocele, a congenital malformation in which abdominal contents protrude into the base of the umbilical cord. The procedure involves surgical correction of the abdominal wall defect.
Service type: Anesthesia for congenital abdominal wall repair (omphalocele)
Typical site of service: Operating room / inpatient or outpatient surgical facility
National Reimbursement Benchmarks
National commercial rates for CPT 00754 cluster around BUCA’s average commercial mean of $71.90, with notable variation across major carriers. Blue Cross Blue Shield (BCBS) and Cigna show higher central tendencies (BCBS median $62.40, Cigna median $85.80) while Aetna and UnitedHealth Group sit lower on median values. Cigna posts the highest single maximum at $151.60, and BCBS peaks at $195.40, reflecting upper-end outliers that lift their means versus BUCA’s average.
Dispersion measured by interquartile range (P75–P25) is narrowest for Aetna at $35.40 and for UnitedHealth Group at $27.60, indicating tighter mid-market clustering. BCBS and Cigna are widest at $41.59 and $54.30 respectively, suggesting the greatest mid-range variability; BUCA’s interquartile span is $38.00, close to the market middle.