Summary & Overview
CPT 00474: Anesthesia for Thoracic Procedures, Chest Wall and Shoulder Girdle
CPT code 00474 represents anesthesia services for procedures on the thorax, including the chest wall and shoulder girdle, when no more specific code applies. This code is significant for hospitals and anesthesia providers nationwide, as it ensures proper billing and documentation for a variety of thoracic procedures that require anesthesia but are not otherwise classified. The code is most frequently used in inpatient hospital settings, reflecting its role in complex surgical cases.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare recognize and reimburse for CPT code 00474, making it a key component in anesthesiology billing practices. Readers will gain insights into payer coverage, typical clinical scenarios, and relevant policy updates associated with this code. The publication also provides context on related codes, common modifiers, and associated clinical diagnoses, offering a comprehensive overview for stakeholders in hospital billing, compliance, and clinical operations.
This summary serves as a resource for understanding the clinical and administrative importance of CPT code 00474, including its role in anesthesia for thoracic procedures, payer coverage, and its place within the broader landscape of anesthesiology coding.
CPT Code Overview
CPT code 00474 is used to report anesthesia services for procedures performed on the thorax, specifically the chest wall and shoulder girdle, when not otherwise specified. This code falls under the anesthesiology service type and is most commonly utilized in the inpatient hospital setting (Place of Service 21). The code is essential for accurately documenting and billing anesthesia care provided during a range of thoracic procedures that do not fit into more specific anesthesia codes.
Clinical & Coding Specifications
Clinical Context
A patient is admitted to an inpatient hospital for a procedure involving the thorax, specifically the chest wall or shoulder girdle, that is not otherwise specified. The patient may present with conditions such as pleural effusion, rib fracture, clavicle fracture, lung disorders, or a malignant neoplasm of the bronchus or lung. An anesthesiology provider, such as a physician anesthesiologist or a Certified Registered Nurse Anesthetist (CRNA), administers anesthesia to facilitate the surgical or diagnostic procedure. The clinical workflow includes preoperative assessment, anesthesia induction, intraoperative monitoring, and postoperative care, with documentation of anesthesia time and relevant modifiers as appropriate.
Coding Specifications
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Modifiers:
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QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia. -
QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia services under the medical direction of a physician anesthesiologist.
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Provider Taxonomies:
| Taxonomy Code | Specialty Description |
|---|---|
207L00000X | Anesthesiology |
367500000X | Certified Registered Nurse Anesthetist |
207LC0200X | Critical Care Medicine (Anesthesiology) |
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Specialties Represented:
- Anesthesiology
- Certified Registered Nurse Anesthetist
- Critical Care Medicine (Anesthesiology)
Related Diagnoses
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J98.4- Other disorders of lung- Relevant for patients undergoing thoracic procedures due to non-specific lung disorders.
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J94.9- Pleural effusion, unspecified- Indicates fluid accumulation in the pleural space, often requiring thoracic intervention.
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S22.3- Fracture of one rib- Associated with trauma to the chest wall, necessitating surgical repair or stabilization.
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S42.001A- Fracture of unspecified part of right clavicle, initial encounter for closed fracture- Represents clavicle fractures, which may require surgical intervention under anesthesia.
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C34.90- Malignant neoplasm of unspecified part of unspecified bronchus or lung- Indicates lung cancer, which may require thoracic surgery and anesthesia for diagnostic or therapeutic procedures.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
00520 | Anesthesia for closed chest procedures | Used for procedures involving the chest that do not require opening; may be an alternative to 00474 depending on procedure specifics. |
00528 | Anesthesia for procedures on the esophagus | Used when the procedure involves the esophagus rather than the chest wall or shoulder girdle. |
00530 | Anesthesia for procedures on the trachea and bronchi | Used for airway procedures; may be used in conjunction with or as an alternative to 00474 if the procedure involves these structures. |
00532 | Anesthesia for procedures on the mediastinum | Used for mediastinal procedures; may be an alternative or used together with 00474 if the procedure extends to the mediastinum. |
- These codes are selected based on the specific anatomical site and procedure type. They may be used as alternatives or, in some cases, together if multiple regions are involved.
National Reimbursement Benchmarks
For CPT code 00474, national mean rates among commercial payers (BUCA average) are $263.52, which are substantially higher than the typical Medicare rates, though Medicare data is not available in the input for direct comparison. Among individual commercial payers, Cigna and Blue Cross Blue Shield report the highest mean rates at $698.32 and $628.13, respectively, while UnitedHealth Group is notably lower at $65.62.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. UnitedHealth Group has the tightest range ($25.67), indicating less variability in reimbursement, while Cigna shows the widest spread ($1,026.00), reflecting substantial rate variation. Blue Cross Blue Shield and Aetna also exhibit considerable dispersion, with ranges of $419.20 and $689.00, respectively.
The table and chart below present a detailed breakdown of national benchmarks for CPT code 00474 by payer, including mean rates and percentile values.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a substantial spread in reimbursement rates for CPT code 00474, particularly among commercial payers. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($295.33) and BUCA ($445.93), indicating significant variability in negotiated rates. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal spread, with nearly flat rates across percentiles, suggesting standardized contracts or limited negotiation.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably higher, while UnitedHealth Group and Cigna remain below or near national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting the diversity in reimbursement across the market.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00474 in Alaska, with a mean rate of $819.25.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
- Alaska's mean rates for most payers, especially BCBS and BUCA, are notably higher than their respective national averages, indicating a premium reimbursement environment.
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.