CPT 00836: Anesthesia for Infant Lower Abdominal Hernia Repair
CPT code 00836 designates anesthesia services for repair of a lower abdominal hernia in an infant born at fewer than 37 weeks gestational age and younger than 50 weeks at the time of surgery. This code covers anesthesia for procedures in the lower abdomen not otherwise specified by other anesthesia codes and is focused on a high-risk neonatal/pediatric population. Nationally, accurate use of this code affects clinical documentation, payment pathways, and case mix reporting for pediatric surgical care.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of the clinical context for neonatal and infant anesthesia in lower abdominal hernia repair, comparisons to related anesthesia codes used for similar procedures, and the common coding scenarios that drive appropriate selection of this code. The publication also outlines typical sites of service and the clinical population covered by the code.
This summary is intended to help coding professionals, anesthesiology departments, billing teams, and policy analysts understand when CPT code 00836 applies, how it relates to adjacent anesthesia codes, and the operational context in which it is commonly used. Data not available in the input.
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Billing Code Overview
CPT code 00836 describes anesthesia services for repair of a lower abdominal hernia in an infant born prematurely (less than 37 weeks gestational age) who is younger than 50 weeks gestational age at the time of surgery. The service type is anesthesia for neonatal/pediatric lower abdominal hernia repair (unspecified procedure within this category). The typical site of service is an operating room or surgical suite in an inpatient or outpatient hospital setting.
National Reimbursement Benchmarks
Commercial rates for CPT 00836 center around BUCA’s mean of $71.9, with notable variation among major carriers. Cigna posts the highest mean at $95.3 and a wide upper spread, while Blue Cross Blue Shield (BCBS) and UnitedHealth Group sit closer to BUCA’s level with means of $69.0 and $67.3 respectively. Aetna’s mean of $61.8 is the lowest among these payers but still within the broader commercial range.
Dispersion (P75 minus P25) highlights differences in contract consistency: Cigna’s dispersion is $56.4 (P75 $123.2 minus P25 $68.0), the widest, indicating greater variability in higher-end reimbursements. Blue Cross Blue Shield’s dispersion is $47.9, BUCA’s is $37.1, UnitedHealth Group’s is $28.8, and Aetna’s is the tightest at $37.2 (P75 $79.2 minus P25 $42.0). These differences reflect where commercial reimbursement is most and least variable.