CPT 00938: Anesthesia for Penile Prosthesis Insertion, Perineal Approach
CPT code 00938 denotes anesthesia services for penile prosthesis insertion via a perineal approach, an operative treatment for erectile dysfunction in men. This code captures the anesthetic management specific to a urologic implant procedure performed through the perineum and is used by providers and payers to classify perioperative anesthesia resources and complexity. Nationally, accurate coding of these services affects claims adjudication, payment consistency, and clinical documentation for male genital surgical anesthesia.
Key payers covered in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 00938, how it relates to other anesthesia codes for male genital procedures, typical sites of service, and which diagnoses commonly support medical necessity for the procedure. The publication also outlines common modifiers and related anesthesia and urology procedure codes for coding workflows, and highlights benchmarking and policy considerations relevant to national payer practices.
This piece is intended for coding professionals, anesthesiology and urology clinicians involved in perioperative documentation, and revenue cycle staff seeking clarity on classification and claims handling for anesthesia tied to penile prosthesis insertion.
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Billing Code Overview
CPT code 00938 describes anesthesia services provided for penile prosthesis insertion performed through the perineum. The procedure is performed to treat erectile dysfunction in men. The service type is anesthesia for a surgical implant procedure on the male genitalia. The typical site of service is an operating room or ambulatory surgical center where urologic surgical procedures are performed.
National Reimbursement Benchmarks
Commercial reimbursement for CPT 00938 centers around a BUCA average commercial rate of $78.00, with variation among major national payers. Cigna and Aetna sit above BUCA on mean rates at $99.70 and $84.80 respectively, while Blue Cross Blue Shield averages $71.80 and UnitedHealth Group $67.90. These means frame a mid-market where BUCA represents an average commercial benchmark rather than an extreme.
Dispersion measured by the interquartile range (P75–P25) is widest for Aetna at $62.50 ($103.70–$41.20), followed by Cigna at $61.80 ($131.80–$70.00). Blue Cross Blue Shield and BUCA show narrower spreads of $38.80 ($93.70–$54.90) and $40.00 ($99.60–$53.80) respectively, while UnitedHealth Group is the tightest at $30.90 ($81.10–$52.00). These differences indicate materially higher variability in allowed amounts for Aetna and Cigna compared with UnitedHealth Group and Blue Cross Blue Shield.