Summary & Overview
CPT 00211: Anesthesia for Intracranial Hematoma or Blood Clot Removal
CPT code 00211 represents anesthesia services for patients undergoing intracranial procedures to remove hematomas or blood clots from the brain or surrounding tissues. This code is significant in neurosurgical care, as it ensures proper billing and reimbursement for complex anesthesia management during these high-risk operations. The code is commonly used in outpatient hospital settings, reflecting advances in surgical techniques and patient care that allow for such procedures outside of inpatient environments.
Major national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Understanding how these payers process claims for CPT code 00211 is essential for providers, billing professionals, and healthcare administrators seeking to navigate policy updates and reimbursement benchmarks.
Readers will gain insight into the clinical context of intracranial anesthesia services, current billing practices, and payer coverage trends. The publication also highlights relevant modifiers, associated taxonomies, and related CPT codes, providing a comprehensive overview for those involved in neurosurgical anesthesia billing and policy. This summary serves as a resource for understanding the national landscape of CPT code 00211 and its role in supporting quality care for patients undergoing critical brain procedures.
CPT Code Overview
CPT code 00211 is used for anesthesia services provided to patients undergoing intracranial procedures. Specifically, this code applies when a provider administers anesthesia for surgeries that involve removing a small portion of skull bone to extract a hematoma or blood clot from within the brain or the surrounding tissues.
Service Type: Anesthesia – Intracranial procedures
Typical Site of Service: Outpatient Hospital (POS 22)
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with symptoms suggestive of an intracranial hematoma, such as sudden headache, neurological deficits, or altered consciousness. Imaging confirms the presence of a blood clot within the brain or surrounding tissues. The neurosurgical team schedules a procedure to remove the hematoma, which involves creating a small opening in the skull. An anesthesiology provider delivers anesthesia services throughout the procedure, ensuring patient safety and comfort. The anesthesia care is documented under CPT code 00211 for intracranial procedures involving hematoma removal.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider is present and monitors the patient, but the patient may not be fully under general anesthesia.P1: A normal healthy patient. Indicates the patient's physical status as normal and healthy, with no underlying conditions.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine (Anesthesiology) |
207LC0200X | Critical Care Medicine (Anesthesiology) |
These taxonomies represent providers specializing in anesthesia, pain management, and critical care within anesthesiology.
Related Diagnoses
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K11.9: Disease of salivary gland, unspecified- Used when the patient has a salivary gland disorder that is not specifically identified. Relevant if the procedure is performed due to an unclear gland pathology.
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K11.5: Sialolithiasis- Indicates the presence of stones in the salivary gland, which may necessitate surgical intervention and anesthesia.
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K11.8: Other specified diseases of salivary glands- Covers salivary gland diseases not classified elsewhere, relevant for less common conditions requiring surgery.
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K11.6: Mucocele of salivary gland- Refers to a cystic lesion in the salivary gland, which may require excision under anesthesia.
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K11.0: Atrophy of salivary gland- Represents shrinkage or loss of function in the salivary gland, potentially leading to surgical management.
Each diagnosis code is clinically relevant as it may indicate the underlying reason for surgical intervention and the need for anesthesia services as described by CPT code 00211.
Related CPT Codes
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42410: Excision of parotid tumor, lateral lobe, without nerve dissection- This code is used for surgical removal of a parotid tumor from the lateral lobe without dissecting the facial nerve. It may be performed in cases where the tumor is accessible and nerve involvement is not suspected.
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42415: Excision of parotid tumor, lateral lobe, with nerve dissection- This code applies when the excision requires dissection of the facial nerve due to tumor proximity or involvement. It is more complex than
42410.
- This code applies when the excision requires dissection of the facial nerve due to tumor proximity or involvement. It is more complex than
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42420: Excision of parotid tumor, total, with nerve dissection- Used for complete removal of the parotid gland with nerve dissection, typically for extensive or malignant tumors.
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42425: Excision of submandibular gland- This code is for surgical removal of the submandibular gland, often due to chronic infection, stones, or tumors.
These codes are related as they represent surgical procedures involving gland excision, which may require anesthesia services similar to those described by CPT code 00211. They may be used together in cases where multiple procedures are performed, or as alternatives depending on the clinical scenario.
National Reimbursement Benchmarks
National mean rates for CPT code 00211 show that BUCA (average commercial) pays $254.10, while Medicare rates are not available in the input. Among commercial payers, Cigna and Blue Cross Blue Shield have the highest mean rates at $553.64 and $535.33, respectively, with UnitedHealth Group significantly lower at $65.58.
Rate dispersion varies widely across payers. Cigna exhibits the widest spread, with a difference of $775.67 between its 75th and 25th percentiles, indicating substantial variability in contracted rates. UnitedHealth Group has the tightest range, with only $25.20 separating its 75th and 25th percentiles, suggesting more consistent reimbursement levels. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska displays a wide spread in reimbursement rates for CPT code 00211, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($222.00), while Aetna and UnitedHealth Group have minimal spread ($0.00 and $4.00, respectively). This indicates that some payers, like Blue Cross Blue Shield and BUCA, offer much higher rates and greater variability compared to others, such as Aetna and UnitedHealth Group, which are more consistent but lower.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are notably higher, while Cigna and UnitedHealth Group are below their respective national means. The table and chart below present the full breakdown of payer-specific rates in Alaska for CPT code 00211.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 00211, with a mean rate of $636.11.
- UnitedHealth Group offers the lowest mean rate at $75.12.
- Alaska's mean rates for most payers, especially Blue Cross Blue Shield and BUCA, are significantly higher than national averages, while Cigna and UnitedHealth Group are below national means.
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