Summary & Overview
CPT 00567: Anesthesia for Coronary Artery Bypass Graft with Pump Oxygenator
CPT code 00567 covers anesthesia services for coronary artery bypass graft procedures requiring a pump oxygenator, a critical component in advanced cardiac surgery. This code is nationally significant due to the prevalence of coronary artery disease and the frequency of bypass operations in hospital settings. The analysis includes coverage details from major payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer policies and reimbursement benchmarks.
Readers will gain insight into the clinical context of 00567, including its role in supporting patient outcomes during complex cardiac procedures. The publication outlines typical sites of service, relevant modifiers, and associated provider taxonomies, offering clarity on billing and documentation requirements. Additionally, the summary highlights related CPT codes and common ICD-10 diagnoses, equipping stakeholders with the information needed to navigate policy updates and understand national trends in anesthesia billing for cardiac surgery. This resource is designed for healthcare professionals, administrators, and policy analysts seeking up-to-date information on anesthesia coding for coronary artery bypass grafts.
CPT Code Overview
CPT code 00567 is used for reporting anesthesia services provided during coronary artery bypass graft procedures that require the use of a pump oxygenator. This code falls under the category of anesthesia for intrathoracic procedures, specifically for complex cardiac surgeries. The typical site of service for this procedure is the hospital inpatient operating room (Place of Service 21), reflecting the high-acuity nature of the intervention. This code is essential for accurately documenting and billing anesthesia care during advanced cardiac operations.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult admitted to the hospital with advanced coronary artery disease, such as atherosclerotic heart disease of the native coronary arteries. The patient is scheduled for a coronary artery bypass graft (CABG) procedure requiring the use of a pump oxygenator. The anesthesia team, which may include an anesthesiology physician or a certified registered nurse anesthetist (CRNA), provides anesthesia services in the operating room during the surgical procedure. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care, all coordinated with the surgical and cardiovascular teams.
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 certified registered nurse anesthetist provides anesthesia services under the medical direction of a physician.
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Provider Taxonomies:
Taxonomy Code Specialty Description 207L00000XAnesthesiology Physician 367500000XCertified Registered Nurse Anesthetist 207RC0000XCardiovascular Disease Physician -
Service Type:
- Anesthesia – Intrathoracic Procedures
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Typical Site of Service:
- Hospital inpatient (Operating Room, POS 21)
Related Diagnoses
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I25.10: Atherosclerotic heart disease of native coronary artery without angina pectoris- Indicates the presence of coronary artery disease without symptoms of angina; relevant for patients undergoing CABG due to significant coronary blockages.
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I25.110: Atherosclerotic heart disease of native coronary artery with unstable angina pectoris- Represents coronary artery disease with unstable angina, often necessitating urgent CABG procedures.
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I25.119: Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris- Used when angina is present but not further specified; supports medical necessity for CABG.
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I25.9: Chronic ischemic heart disease, unspecified- Broadly covers chronic ischemic heart conditions, which may require surgical intervention such as CABG.
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Z95.1: Presence of aortocoronary bypass graft- Indicates a history of CABG; relevant for patients undergoing repeat procedures or evaluation of prior grafts.
Related CPT Codes
| CPT Code | Description |
|---|---|
00566 | Under anesthesia for coronary artery bypass graft procedure; not requiring pump oxygenator |
00580 | Under anesthesia for heart transplant or heart and lung transplant |
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00566is used for CABG procedures that do not require a pump oxygenator, serving as an alternative to00567when the pump is not used. -
00580is used for anesthesia services during heart or heart and lung transplant procedures, which may involve similar clinical teams and workflows but represent distinct surgical interventions. -
These codes are not typically used together but may be selected as alternatives based on the specific procedure performed.
National Reimbursement Benchmarks
National mean rates for CPT code 00567 show that BUCA (average commercial) is at $459.85, while UnitedHealth Group is significantly lower at $65.53. Blue Cross Blue Shield, Aetna, and Cigna all report higher mean rates, with Cigna leading at $962.78. The mean rate for BUCA is less than half of Cigna's, highlighting substantial variation among commercial payers.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Aetna ($1,237.87) and Cigna ($1,468.00), indicating broad variability in contracted rates. Blue Cross Blue Shield shows a tighter range ($562.67), while UnitedHealth Group has the narrowest spread ($25.33), suggesting more consistent rates nationally. 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 spread in reimbursement rates for CPT code 00567, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($661.07), while Aetna, Cigna, and UnitedHealth Group display minimal spreads, indicating consistent rates across providers. The mean rates for Blue Cross Blue Shield and BUCA in Alaska are notably higher than their respective national averages, whereas Cigna and UnitedHealth Group are below national benchmarks.
The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting the significant variation in reimbursement across payers for this procedure.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00567 in Alaska, with a mean rate of $1,211.62.
- 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 benchmarks.
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.