Summary & Overview
CPT 00472: Anesthesia for Partial Rib Resection
CPT code 00472 represents anesthesia for partial rib resection, a procedure commonly performed in outpatient hospital settings. This code is significant for anesthesiology professionals and billing teams, as it ensures proper documentation and reimbursement for anesthesia services during rib resection surgeries. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its widespread use and importance in clinical practice.
Readers will gain insight into the clinical context of partial rib resection, the typical site of service, and the key payers covering this code. The publication provides an overview of relevant benchmarks, policy updates, and billing considerations associated with anesthesia for partial rib resection. Additionally, it highlights common modifiers and associated taxonomies, offering a comprehensive understanding of how this code fits within broader anesthesiology and critical care billing practices. The summary also addresses related CPT codes and ICD-10 diagnoses, helping readers navigate the nuances of coding and reimbursement for thoracic anesthesia procedures. This information is valuable for healthcare administrators, coding professionals, and clinicians seeking clarity on national billing standards and payer coverage for anesthesia services in rib resection cases.
CPT Code Overview
CPT code 00472 is used to report anesthesia services for partial rib resection procedures. This code applies specifically to cases where anesthesia is administered during the surgical removal of part of a rib. The service type is anesthesia, and the typical site of service is an outpatient hospital setting (Place of Service 22). This code is essential for accurately documenting and billing anesthesia care provided during partial rib resection surgeries.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient hospital (Place of Service 22) for a partial rib resection, typically indicated for conditions such as chest wall deformities, trauma, or localized disease requiring removal of part of a rib. The procedure is performed under anesthesia, with an anesthesiologist or anesthesia assistant providing care. The clinical workflow involves preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative recovery. The patient is generally healthy, as indicated by modifier P1, and may require monitored anesthesia care, denoted by modifier QS.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia.P1: A normal healthy patient. Indicates the patient's physical status as normal and healthy.
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Provider Taxonomies:
Code Specialty 207L00000XAnesthesiology 207LA0401XAnesthesiology Assistant 207LC0200XCritical Care Medicine (Anesthesiology)
These taxonomies represent providers qualified to deliver anesthesia services for partial rib resection, including anesthesiologists, anesthesia assistants, and those specializing in critical care medicine within anesthesiology.
Related Diagnoses
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H25.9: Unspecified age-related cataract- Not clinically relevant to partial rib resection; likely included in error or as a placeholder.
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H26.9: Unspecified cataract- Not clinically relevant to partial rib resection; likely included in error or as a placeholder.
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H52.4: Presbyopia- Not clinically relevant to partial rib resection; likely included in error or as a placeholder.
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H53.8: Other visual disturbances- Not clinically relevant to partial rib resection; likely included in error or as a placeholder.
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H54.8: Legal blindness, as defined in USA- Not clinically relevant to partial rib resection; likely included in error or as a placeholder.
The provided ICD-10 codes do not directly relate to the clinical indications for partial rib resection and anesthesia. They may have been included for reference or as placeholders.
Related CPT Codes
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00474: Under anesthesia for procedures on the thorax (chest wall and shoulder girdle) — anesthesia for partial rib resection (radical)- This code is used when the partial rib resection is more extensive or radical compared to the procedure described by
00472. It may be selected as an alternative based on surgical complexity.
- This code is used when the partial rib resection is more extensive or radical compared to the procedure described by
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00470: Under anesthesia for procedures on the thorax (chest wall and shoulder girdle) — anesthesia for partial rib removal, unspecified procedure- This code covers anesthesia for rib removal procedures that are not specifically partial or radical. It may be used in cases where the surgical details are less defined.
These codes are related to 00472 and may be used as alternatives depending on the extent and specifics of the rib resection procedure. They are not typically billed together but may be selected based on the surgical approach.
National Reimbursement Benchmarks
National mean rates for CPT code 00472 show that commercial payers such as Blue Cross Blue Shield, Cigna, and Aetna reimburse at significantly higher levels than UnitedHealth Group and the BUCA average. The BUCA mean rate is $224.41, while UnitedHealth Group is notably lower at $65.61. Medicare rates are not available in the input for comparison.
Rate dispersion varies widely across payers. Cigna exhibits the greatest spread, with a difference of $775.67 between its 75th and 25th percentiles, indicating substantial variability in contracted rates. In contrast, UnitedHealth Group has the tightest range, with only $25.75 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 00472, with Blue Cross Blue Shield showing the largest rate spread ($222.00) between the 75th and 25th percentiles, while Aetna, Cigna, and UnitedHealth Group have minimal spreads ($0.00 to $4.00). This indicates that Blue Cross Blue Shield's rates are not only the highest but also more variable compared to other payers in the state. The mean rates for most payers in Alaska, particularly Blue Cross Blue Shield, are substantially higher than their respective national averages, highlighting Alaska as a high-reimbursement market for this code.
The table and chart below present the full breakdown of payer-specific mean rates and percentile values for CPT code 00472 in Alaska, allowing for direct comparison across Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealth Group.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 00472, with a mean rate of $635.97.
- UnitedHealth Group offers the lowest mean rate at $75.12.
- Alaska's mean rates for most payers, especially Blue Cross Blue Shield, are significantly higher than national averages, except for UnitedHealth Group, which is only slightly above the national mean.
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.