Summary & Overview
CPT 00100: Anesthesia for Salivary Gland Procedures, Including Biopsy
CPT 00100 denotes anesthesia services provided for procedures on the salivary glands, including biopsies, and represents a focused anesthesiology service tied to head and neck minor surgical interventions. Nationally, this code matters because it captures the anesthetic component of commonly performed salivary gland procedures and influences billing, clinical workflow, and resource allocation in outpatient hospital settings. Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find a concise policy and billing context for CPT 00100, including payer coverage considerations, common modifiers used to reflect monitoring or CRNA involvement, associated clinical diagnoses that typically prompt salivary gland procedures, and related surgical CPT cross-references for parotid, submandibular, and sublingual gland excisions. The publication outlines reimbursement policy features, coding relationships, and operational considerations relevant to anesthesiology teams and billing staff. It does not provide clinical guidance or recommendations for care but supplies the billing framework and coding context needed to align coding entries with procedural documentation and payer rules. Data not available in the input is noted where applicable.
CPT Code Overview
CPT 00100 covers anesthesia for procedures on salivary glands, including biopsy. This code is used when anesthesia services are provided to facilitate operative or diagnostic procedures involving salivary gland tissue. The service type for CPT 00100 is Anesthesiology, and the typical site of service is Outpatient Hospital (POS 22).
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A middle-aged adult presents to the outpatient hospital ambulatory surgical unit with painful swelling and recurrent infections of the submandibular region. Imaging (ultrasound or CT) demonstrates a salivary gland lesion or obstructing sialolith. The surgical team schedules an excision or biopsy of the affected salivary gland under anesthesia. The patient arrives fasting, is evaluated by the anesthesia team in preoperative holding, and standard ASA monitoring and consent are completed. In the operating room, general anesthesia or monitored anesthesia care is administered per anesthesiologist or certified registered nurse anesthetist plan while the surgeon performs gland excision or biopsy. Postoperative recovery occurs in the PACU with routine discharge criteria for outpatient hospital status, or admission if complications arise.
Coding Specifications
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Common modifiers:
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QS: Monitored anesthesia care service. Use when anesthesia documentation indicates monitored anesthesia care was provided for the salivary gland procedure. -
QX: CRNA service with medical direction by a physician. Use when a certified registered nurse anesthetist provided the anesthesia service under physician medical direction and documentation supports the medical direction elements. -
Associated provider taxonomies:
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207L00000X— Anesthesiology: Physicians specializing in anesthesia care, perioperative management, and pain control. -
367500000X— Certified Registered Nurse Anesthetist: Advanced practice nurses providing anesthesia services, including MAC and general anesthesia, often under supervision or direction arrangements. -
207RA0401X— Anesthesiology Assistant: Allied health professionals practicing under anesthesiologist supervision to assist in anesthesia delivery and perioperative management.
Related Diagnoses
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K11.9— Disease of salivary gland, unspecifiedClinical relevance: Represents non-specific salivary gland pathology where surgical biopsy or excision may be indicated; anesthesia services for those procedures are reported with
00100. -
K11.5— SialolithiasisClinical relevance: Obstructing salivary gland stones can necessitate surgical removal or gland excision; anesthesia for these procedures is reported with
00100. -
K11.8— Other specified diseases of salivary glandsClinical relevance: Includes specified salivary gland disorders (other than sialolithiasis) that may require biopsy or excision; anesthesia care for those operative interventions is reported with
00100.
Related CPT Codes
| CPT Code | Description |
|---|---|
42410 | Excision of parotid tumor |
42415 | Excision of submandibular gland |
42420 | Excision of sublingual gland |
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42410: Parotid tumor excision is a salivary gland surgical procedure that commonly requires anesthesia coded with00100for anesthesia services when the parotid gland is the operative site. -
42415: Submandibular gland excision is another salivary gland removal procedure for which00100describes the anesthesia service; this procedure may occur alongside targeted gland biopsy or stone removal. -
42420: Sublingual gland excision is a related surgical option for salivary gland disease;00100applies to the anesthesia provided for this procedure. -
Common workflow relationships: the listed surgical CPT codes are the operative services for which anesthesia code
00100documents the anesthetic management. These codes are commonly used together in the sense that00100is reported for anesthesia when any of these gland excisions or biopsies are performed; they also serve as clinical alternatives depending on gland involved.
National Reimbursement Benchmarks
National commercial mean rates are generally higher than the Medicare-level benchmark represented here by BUCA (average commercial). BUCA’s mean allowed rate is $178.30 compared with a Medicare placeholder mean of $0.00 in the input; among commercial payers, Aetna ($271.71), Blue Cross Blue Shield ($299.39), and Cigna ($299.13) report substantially higher mean rates, while UnitedHealth Group’s mean ($65.53) is lower.
Rate dispersion (P75 minus P25) varies markedly across payers. Aetna shows a wide spread ($372.00), Cigna also shows a wide spread ($344.00), and BUCA’s spread is moderate ($205.67). Blue Cross Blue Shield’s spread is narrower ($178.00). UnitedHealth Group displays the tightest distribution among these payers ($25.50). The table and chart below present the full breakdown.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide rate spread for CPT code 00100, particularly among commercial payers. Blue Cross Blue Shield shows the largest spread, with a 75th percentile rate of $371.50 and a 25th percentile of $274.60, resulting in a $96.90 difference. In contrast, Aetna, Cigna, and UnitedHealth Group have minimal spreads, each with only a few dollars between their percentiles, indicating more uniform reimbursement rates. The mean rates in Alaska for most payers are notably different from national averages. Blue Cross Blue Shield's mean rate in Alaska is higher than its national mean, while Aetna and BUCA are lower than their respective national means. Cigna and UnitedHealth Group also show lower mean rates in Alaska compared to national benchmarks. The table and chart below present the full breakdown of payer-specific reimbursement rates for CPT code 00100 in Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield has the highest mean rate in Alaska at $330.45, while UnitedHealth Group is the lowest at $75.12.
- The rate spread is substantial, with BCBS's 75th percentile ($371.50) far exceeding Aetna, Cigna, and UnitedHealth Group.
- Compared to national averages, Aetna and BUCA mean rates in Alaska are lower, while BCBS is higher than its national mean.
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