CPT 00904: Anesthesia for Radical Perineal Procedure
CPT code 00904 represents anesthesia services delivered for radical perineal procedures — major surgical interventions involving complete removal of diseased tissue in the perineal and genital area. Nationally, this code is relevant for billing and clinical documentation in hospitals and surgical centers where complex perineal operations occur and where anesthesia teams manage high-risk, invasive procedures.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the code, typical sites of service, and how the code maps to related surgical procedures. The publication outlines common billing considerations and associated clinical scenarios (for example, procedures addressing penile and perineal disease) and highlights related procedural codes that commonly appear on the same claim. Policy and reimbursement benchmark summaries identify payer coverage patterns and coding practice themes important for compliance and revenue cycle staff.
This summary provides clinicians, anesthesia departments, and billing teams a clear reference for when 00904 applies, how it fits into procedural workflows, and which clinical situations typically generate use of the code. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 00904 describes anesthesia services provided for a radical perineal procedure, defined as complete removal of all diseased tissue in the perineal region. The primary service type is anesthesia for major perineal surgery, supporting surgical teams during extensive procedures in the genital and perineal area. The typical site of service is an operating room or surgical suite where radical perineal procedures are performed under monitored anesthesia care or general/regional anesthesia.
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.