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    v1.0.28
    OpenPayerBilling CodesAnesthesia for Procedures on the Lower AbdomenCPT cpt-00820-anesthesia-lower-posterior-abdominal-wall-procedures
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    CPT 00820: Anesthesia for Lower Posterior Abdominal Wall Procedures

    Commercial payers pay $74 on average nationally for this procedure.

    CPT code 00820 describes anesthesia services provided for procedures on the lower posterior (rear) abdominal wall, including biopsies, tumor resections, muscle flap procedures, and targeted injections; service type: anesthesia for lower posterior abdominal wall procedures; typical site of service: operating room or procedure suite where surgical or invasive diagnostic interventions on the posterior lower abdominal wall are performed.

    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

    For CPT 00820 the commercial landscape centers on BUCA’s average commercial rate of $74.50, which aligns with the mid-range of individual payer means. Blue Cross Blue Shield’s mean is similar to BUCA, Aetna and UnitedHealth Group sit slightly lower, and Cigna’s mean is noticeably higher at $96.50. This positioning frames BUCA as a baseline for commercial comparisons while highlighting Cigna as an outlier on the upper end of mean rates.

    Dispersion (P75 minus P25) highlights variability across payers: Aetna’s interquartile range is $46.70, Blue Cross Blue Shield’s is $37.00, BUCA’s is $40.90, Cigna’s is $58.20, and UnitedHealth Group’s is $28.90. UnitedHealth Group displays the tightest band ($28.90), indicating relatively concentrated commercial pricing, while Cigna shows the widest spread ($58.20), reflecting the greatest variability among commercial contracts.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 42-year-old male presents to the general surgery clinic with a painful, reducible right inguinal bulge and intermittent nausea. Examination and ultrasound are consistent with a unilateral inguinal hernia. The surgeon schedules an open or laparoscopic hernia repair under general anesthesia. Preoperative evaluation is performed in the preoperative holding area by the anesthesia team (Certified Registered Nurse Anesthetist or Anesthesiologist Assistant supervised by an Anesthesiologist). On the day of surgery the patient receives induction of general anesthesia, endotracheal intubation, intraoperative anesthetic management including monitoring and analgesia, and emergence with postoperative handoff to PACU staff. Anesthesia services coded to 00820 cover procedures on the lower rear abdominal wall (eg, inguinal or ventral hernia repairs, muscle flap procedures, local biopsies) when anesthesia is required for surgical access and patient comfort. Typical workflow includes pre-op assessment, intraoperative management for the duration of the operative procedure, and immediate postoperative recovery monitoring. Common settings are ambulatory surgery centers, hospital outpatient departments, and inpatient operating rooms depending on procedure complexity and patient comorbidities.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49505Repair initial inguinal hernia, age 5 years or older; reducibleCommon surgical procedure performed on the lower anterior abdominal wall for which anesthesia code may be reported when anesthesia is provided for inguinal hernia repair.

    Related Modifiers

    8 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…
    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…
    367H00000XAnesthesiologist AssistantAn individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants …
    367500000XCertified Registered Nurse Anesthetist(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, prov…
    207KI0005XClinical & Laboratory Immunology (Allergy & Immunology) PhysicianAn allergy and immunology physician who specializes in clinical and laboratory immunology disease management..
    2085R0205XRadiological Physics PhysicianA radiological physicist deals with the diagnostic and therapeutic applications of roentgen rays, gamma rays from sealed sources, ultrasonic radiation…
    1223D0004XDental AnesthesiologyA dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years durati…
    2084P0805XGeriatric Psychiatry PhysicianGeriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders…
    364SP0200XPediatric Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    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-00800-LOWER-ANTERIOR-ABDOMINAL-WALL-ANESTHESIA

    CPT 00800: Anesthesia for Lower Anterior Abdominal Wall Procedures

    CPT-00802-PANNICULECTOMY-LOWER-ANTERIOR-ABDOMINAL-WALL-ANESTHESIA

    CPT 00802: Anesthesia for Panniculectomy, Lower Anterior Abdominal Wall

    CPT-00811-ANESTHESIA-LOWER-INTESTINAL-ENDOSCOPY

    CPT 00811: Anesthesia for Lower Intestinal Endoscopic Procedure Pre-Duodenal

    CPT-00812-ANESTHESIA-COLONOSCOPY-BELOW-DUODENUM

    CPT 00812: Anesthesia for Colonoscopy Accessing Intestines Below Duodenum

    CPT-00813-ANESTHESIA-COMBINED-UPPER-LOWER-INTESTINAL-ENDOSCOPY

    CPT 00813: Anesthesia for Combined Upper and Lower Intestinal Endoscopy

    CPT-00830-LOWER-ABDOMINAL-HERNIA-ANESTHESIA-UNSPECIFIED

    CPT 00830: Anesthesia for Lower Abdominal Hernia Repair, Unspecified

    CPT-00832-ANESTHESIA-LOWER-ABDOMEN-HERNIA-REPAIR

    CPT 00832: Anesthesia for Lower Abdominal Hernia Repair

    CPT-00834-INFANT-LOWER-ABDOMEN-HERNIA-ANESTHESIA

    CPT 00834: Anesthesia for Infant Lower Abdominal Hernia Repair

    CPT-00836-ANESTHESIA-INFANT-LOWER-ABDOMINAL-HERNIA-REPAIR

    CPT 00836: Anesthesia for Infant Lower Abdomen Hernia Repair

    CPT-00840-LOWER-ABDOMEN-INTRAPERITONEAL-ANESTHESIA-LAPAROSCOPY

    CPT 00840: Anesthesia for Lower Abdominal Intraperitoneal Procedures

    Showing 1–10 of 26

    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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    00820
    44950AppendectomyAlthough appendectomy is a lower abdominal procedure, it may coexist with or be considered in differential operative planning; 00820 applies to procedures on the lower rear abdominal wall and may be used when anesthesia covers adjacent lower abdominal surgeries as clinically appropriate.
    49585Repair umbilical hernia, age 5 years or older; reducibleUmbilical hernia repair involves the lower abdominal wall; anesthesia services for this procedure may be billed under 00820 when the anesthesia coverage matches the operative site and complexity.
    49650Laparoscopy, surgical; repair initial inguinal herniaLaparoscopic inguinal hernia repair is an operative approach for inguinal hernia; anesthesia code 00820 applies when anesthesia services are provided for this anatomic region and procedure.