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    v1.0.28
    OpenPayerBilling CodesAnesthesia for Procedures on the Lower AbdomenCPT cpt-00860-anesthesia-extraperitoneal-lower-abdomen-urinary-tract
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    CPT 00860: Anesthesia for Extraperitoneal Lower Abdominal and Urinary Tract Procedures

    Commercial payers pay $87 on average nationally for this procedure.

    CPT code 00860 describes anesthesia services provided for extraperitoneal procedures in the lower abdomen, including the urinary tract, typically delivered as intraoperative anesthesia care for surgical procedures in the lower abdominal region; service type: anesthesia for extraperitoneal lower abdominal surgery; typical site of service: operating room or surgical suite for lower abdominal/urinary tract 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 rates for CPT 00860 cluster around the BUCA average commercial rate of $86.80, with some payers paying materially more and others materially less. Blue Cross Blue Shield presents a relatively tight middle band around its interquartile range ($92.50 - $51.10), while UnitedHealth Group and Cigna offer moderate spreads. Aetna shows the highest top-of-market ceiling ($452.60) and a pronounced skew toward higher outliers compared with other commercial payers.

    Examining dispersion (P75 minus P25) highlights where variability is concentrated: Aetna’s IQR is $135.00, Cigna’s is $37.80, Blue Cross Blue Shield’s is $41.40, UnitedHealth Group’s is $30.00, and BUCA’s is $56.30. Aetna is the widest by far, indicating the greatest heterogeneity in commercial payments, while UnitedHealth Group is the tightest, reflecting relatively concentrated commercial reimbursement levels.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old male presents with a painful, reducible right inguinal bulge and intermittent lower abdominal cramping. Surgical evaluation diagnoses a unilateral inguinal hernia without obstruction (K40.90) with planned elective open hernia repair using an extraperitoneal approach under general anesthesia with an endotracheal tube. Preoperative assessment documents hypertension and controlled type 2 diabetes; ASA physical status is P3. The anesthesia team (physician anesthesiologist or Certified Registered Nurse Anesthetist) performs induction, endotracheal intubation, maintenance of general anesthesia, intraoperative monitoring, and emergence. Anesthesia services are reported with 00860 for extraperitoneal procedures in the lower abdomen, including urinary tract. Typical workflow: preoperative evaluation and consent, anesthesia induction in the OR, provision of anesthesia during extraperitoneal hernia repair, intraoperative management of hemodynamics and analgesia, and postoperative handoff to PACU nursing for recovery and pain control.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    00862Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper one third of ureter, or donor nephrectomy

    Related Modifiers

    9 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…
    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…
    367500000XCertified Registered Nurse Anesthetist(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, prov…
    207RA0401XAddiction Medicine (Internal Medicine) PhysicianAn internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified b…
    156FX1101XOphthalmic AssistantAn ophthalmic assistant assists ophthalmologists by performing duties including, but not limited to, patient charting, patient education, and basic ey…
    2471C1101XCardiovascular-Interventional Technology Radiologic TechnologistA radiologic technologist who specializes in cardiovascular interventional technology.
    364SS0200XSchool Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    246ZB0600XBiostatiscianNone
    335U00000XOrgan Procurement OrganizationA federally designated organization that works with hospital personnel in retrieval of organs for transplantation. The federal government designates a…

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 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
    Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_BlocksCigna2026-05-15
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01

    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-00820-ANESTHESIA-LOWER-POSTERIOR-ABDOMINAL-WALL-PROCEDURES

    CPT 00820: Anesthesia for Lower Posterior Abdominal Wall Procedures

    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

    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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    Closely related; used for similar extraperitoneal lower abdominal procedures that extend to renal/upper ureter surgery and donor nephrectomy; selection depends on the specific surgical site and extent.