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    v1.0.28
    OpenPayerBilling CodesAnesthesia for Procedures on the PerineumCPT cpt-00904-anesthesia-radical-perineal-procedure
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    CPT 00904: Anesthesia for Radical Perineal Procedure

    Commercial payers pay $76 on average nationally for this procedure.

    CPT code 00904 describes anesthesia services provided for a radical (complete removal of all diseased tissue) perineal procedure, representing intraoperative anesthesia care for extensive surgical operations in the perineal region; typical service type is anesthesia and the typical site of service is an operating room or ambulatory surgical center where definitive perineal surgical excision is 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

    National commercial reimbursement for CPT 00904 centers on an average (BUCA) commercial rate of $75.60. Among named payers, Cigna and Aetna sit at the higher ends of central tendency measures (Cigna mean $94.20, Aetna mean $86.90), while Blue Cross Blue Shield and UnitedHealth Group report lower means ($68.50 and $67.30 respectively). This picture positions the BUCA average in the mid-range of commercial reimbursements, reflecting a market where some payers pay substantially more than the BUCA average and others pay modestly less. Dispersion measured by the interquartile range (P75–P25) varies noticeably: Aetna’s IQR is $58.00 (P75 $103.00 minus P25 $45.00), Cigna’s IQR is $53.30 (P75 $121.10 minus P25 $68.00), and Blue Cross Blue Shield’s IQR is $44.50 (P75 $90.00 minus P25 $49.50). UnitedHealth Group shows the tightest spread at $28.80 (P75 $80.80 minus P25 $52.00), indicating more consistent midrange payments, while Aetna and Cigna display the widest variability among major commercial payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old male presents with progressive difficulty urinating, recurrent balanitis, and chronic phimosis. Conservative measures failed and urology plans a radical perineal procedure to remove all diseased tissue around the perineum and distal penile structures; general endotracheal anesthesia is requested due to anticipated operative time and need for complete immobility. Preoperative evaluation by the anesthesia team documents American Society of Anesthesiologists (ASA) physical status P3 for controlled comorbidities (e.g., hypertension, type 2 diabetes). On the day of surgery the patient is transported to the ambulatory surgery center (or hospital operating room for more complex cases). Standard intraoperative monitoring is applied, induction with intravenous agents and endotracheal intubation performed by an anesthesiologist or a certified registered nurse anesthetist supervised by an anesthesiologist. Regional blocks are considered adjuncts for postoperative analgesia. The anesthesiology service codes 00904 for anesthesia for radical perineal procedure, documenting pre‑anesthesia evaluation, intraoperative management, and immediate postoperative handoff to recovery. Potential intraoperative events (significant blood loss, conversion or complication requiring return to operating room) may require modifier reporting per payer policy. Postoperative recovery includes pain control, monitoring for urinary complications, and discharge planning or inpatient admission based on clinical stability and procedure extent.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    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…
    207LA0401XAddiction Medicine (Anesthesiology) PhysicianAn anesthesiologist who specializes in the diagnosis and treatment of addictions.
    207LP2900XPain Medicine (Anesthesiology) PhysicianAn anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chr…
    261QI0500XInfusion Therapy Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    207WX0120XCornea and External Diseases Specialist PhysicianAn ophthalmologist who specializes in diseases of the cornea, sclera, eyelids, conjunctiva, and anterior segment of the eye.
    261QM1300XMulti-Specialty Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    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…
    207XX0801XOrthopaedic Trauma PhysicianRecognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic trauma surgeons deal with the eval…

    Related ICD-10-CM Codes

    31 rows

    ICD-10-CM CodeDescription
    C44.519Basal cell carcinoma of skin of other part of trunk
    C51.9Malignant neoplasm of vulva, unspecified
    C60.9Malignant neoplasm of penis, unspecified
    C63.9Malignant neoplasm of male genital organ, unspecified
    C76.2Malignant neoplasm of abdomen
    C79.82Secondary malignant neoplasm of genital organs
    C84.49Peripheral T-cell lymphoma, not elsewhere classified, extranodal and solid organ sites
    F18.129Inhalant abuse with intoxication, unspecified
    K62.5Hemorrhage of anus and rectum
    K63.5Polyp of colon

    Showing 1–10 of 31

    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-00902-ANESTHESIA-FOR-ANUS-RECTUM-PROCEDURES

    CPT 00902: Anesthesia for Procedures Involving Anus or Rectum

    CPT-00906-ANESTHESIA-FOR-VULVECTOMY

    CPT 00906: Anesthesia for Vulvectomy

    CPT-00908-ANESTHESIA-PERINEAL-PROSTATECTOMY

    CPT 00908: Anesthesia for Perineal Prostatectomy

    CPT-00910-ANESTHESIA-TRANSURETHRAL-URETHROCYSTOSCOPY

    CPT 00910: Anesthesia for Transurethral Procedures including Urethrocystoscopy

    CPT-00912-TRANSURETHRAL-BLADDER-TUMOR-EXCISION-ANESTHESIA

    CPT 00912: Anesthesia for Transurethral Excision of Bladder Tumor

    CPT-00914-ANESTHESIA-TRANSURETHRAL-PROSTATE-REMOVAL

    CPT 00914: Anesthesia for Transurethral Prostate Procedure

    CPT-00916-ANESTHESIA-FOR-TRANSURETHRAL-BLEEDING-CONTROL

    CPT 00916: Anesthesia for Bleeding Control After Transurethral Tissue Removal

    CPT-00918-ANESTHESIA-FOR-URETERAL-STONE-FRAGMENTATION-REMOVAL

    CPT 00918: Anesthesia for Ureteral Stone Fragmentation/Removal

    CPT-00920-ANESTHESIA-FOR-MALE-GENITAL-PROCEDURE-UNSPECIFIED

    CPT 00920: Anesthesia for Male Genitalia Procedure, Unspecified

    CPT-00921-ANESTHESIA-VASECTOMY

    CPT 00921: Anesthesia for Vasectomy

    Showing 1–10 of 25

    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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    54150
    Circumcision, using clamp or other device
    May be an alternative or less extensive procedure for conditions such as phimosis or balanitis when radical perineal excision is not required.
    54160Circumcision, surgical excision other than clamp, device or dorsal slitSurgical alternative for penile/foreskin pathology; may be performed in same anatomic region for related indications.
    54235Removal of penile prosthesisDifferent indication but involves perineal/penile operative field; anesthesia planning and positioning considerations overlap.
    55700Biopsy, prostate; needle or punch, single or multiple, any approachMay be performed in the same operative episode for concurrent lower urinary tract pathology such as BPH with suspicious lesions.