Summary & Overview
CPT 00404: Anesthesia for Radical Breast and Integumentary Procedures
CPT code 00404 is a critical billing code for anesthesia services provided during radical or modified radical breast procedures, as well as surgeries involving the integumentary system on the extremities, anterior trunk, and perineum. This code is widely recognized across the United States and is integral to ensuring proper reimbursement and documentation for anesthesiology services in both hospital inpatient and ambulatory surgical center settings.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, cover services billed under CPT code 00404, making it relevant for providers and facilities seeking to understand payer policies and coverage nuances.
This publication offers a comprehensive overview of CPT code 00404, including its clinical context, typical sites of service, and associated benchmarks. Readers will gain insights into policy updates, billing practices, and the importance of accurate coding for anesthesia care during complex breast and integumentary procedures. The analysis also highlights common modifiers and related taxonomies, providing a well-rounded perspective for stakeholders in anesthesiology, dermatology, and plastic surgery.
CPT Code Overview
CPT code 00404 is used to report anesthesia services for radical or modified radical procedures on the breast, as well as procedures on the integumentary system involving the extremities, anterior trunk, and perineum. This code falls under the anesthesiology service type and is typically performed in a hospital inpatient setting or an ambulatory surgical center (place of service 21 or 24). The code is essential for accurately documenting and billing anesthesia care provided during complex surgical interventions on the breast and related anatomical regions.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a female patient admitted to a hospital inpatient unit or ambulatory surgical center for a radical or modified radical breast procedure, such as mastectomy or breast reconstruction. The patient may have a history of breast cancer, lobular carcinoma in situ, or require surgery following a previous mastectomy. An anesthesiologist or certified registered nurse anesthetist (CRNA) provides anesthesia services during the surgical intervention, ensuring patient comfort and safety throughout the procedure.
Coding Specifications
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Modifiers:
Modifier Code Description When Used QSMonitored anesthesia care service Used when anesthesia is provided as monitored anesthesia care rather than general anesthesia. QXCRNA service with medical direction by a physician Used when a CRNA provides anesthesia services under the medical direction of a physician. -
Provider Taxonomies:
Taxonomy Code Specialty 207L00000XAnesthesiology 207N00000XDermatology 208200000XPlastic Surgery -
Site of Service:
- Hospital inpatient (Place of Service 21)
- Ambulatory surgical center (Place of Service 24)
Related Diagnoses
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C50.911- Malignant neoplasm of unspecified site of right female breast- Indicates a diagnosis of breast cancer in the right breast, relevant for patients undergoing radical breast surgery.
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C50.912- Malignant neoplasm of unspecified site of left female breast- Indicates a diagnosis of breast cancer in the left breast, relevant for patients undergoing radical breast surgery.
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Z42.1- Encounter for breast reconstruction following mastectomy- Used for patients presenting for reconstructive surgery after mastectomy, often following breast cancer treatment.
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Z85.3- Personal history of malignant neoplasm of breast- Indicates a patient with a history of breast cancer, relevant for follow-up or reconstructive procedures.
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D05.11- Lobular carcinoma in situ of right breast- Represents a non-invasive breast lesion, which may necessitate surgical intervention and anesthesia services.
Related CPT Codes
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00404- Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast- This code is used for anesthesia services provided during radical or modified radical breast procedures, such as mastectomy or breast reconstruction. It is the primary CPT code for these anesthesia services and is commonly used in conjunction with surgical CPT codes for breast procedures. No alternative or additional CPT codes are provided in the input.
National Reimbursement Benchmarks
National mean rates for CPT code 00404 show that Blue Cross Blue Shield and Cigna have the highest average reimbursement, with mean rates of $293.48 and $299.28 respectively. UnitedHealth Group's mean rate is significantly lower at $65.59. The BUCA average commercial mean rate stands at $165.29.
Rate dispersion varies notably across payers. Blue Cross Blue Shield exhibits the tightest spread, with a difference of $161.72 between its 75th and 25th percentiles. Cigna has the widest range, with a $344.00 difference between its 75th and 25th percentiles. UnitedHealth Group's rates are tightly clustered, with a $25.27 spread. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide rate spread for CPT code 00404, particularly among Blue Cross Blue Shield and BUCA, where the difference between the 75th and 25th percentiles exceeds $96 and $158 respectively. This indicates significant variability in reimbursement rates depending on payer and provider contracts. In contrast, Aetna, Cigna, and UnitedHealth Group show much narrower spreads, with their 25th, 50th, and 75th percentiles clustered closely together, suggesting more uniform payment structures.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are notably higher, while Aetna and Cigna are lower than their respective national means. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting these differences and the overall distribution across the major commercial payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00404 in Alaska, with a mean rate of $330.24.
- UnitedHealth Group offers the lowest mean rate at $75.12.
- Alaska's mean rates for most payers are higher than national averages, especially for Blue Cross Blue Shield and BUCA.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.