Summary & Overview
CPT 00797: Anesthesia for Upper Abdominal Intraperitoneal Procedures
CPT code 00797 represents anesthesia for intraperitoneal procedures in the upper abdomen, including laparoscopy, when not otherwise specified. This code is significant for hospitals and anesthesia providers nationwide, as it covers a range of complex surgical interventions requiring specialized anesthesia care. The publication examines coverage and policy considerations from major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Readers will gain insight into the clinical context of 00797, typical sites of service, and its role in supporting accurate billing for upper abdominal surgeries. The summary includes benchmarks, policy updates, and relevant clinical scenarios, helping stakeholders understand how this code fits into broader anesthesiology practice and reimbursement frameworks. Key modifiers and associated provider taxonomies are also discussed, providing a comprehensive overview of coding requirements and payer expectations. The publication is designed to inform healthcare professionals, administrators, and policy analysts about the latest developments and best practices related to anesthesia billing for upper abdominal procedures.
CPT Code Overview
CPT code 00797 is used to report anesthesia services for intraperitoneal procedures in the upper abdomen, including laparoscopy, when not otherwise specified. This code falls under the anesthesiology service type and is most commonly performed in an inpatient hospital setting (Place of Service 21). The code is essential for accurately documenting and billing anesthesia care provided during complex abdominal surgeries, ensuring proper reimbursement and compliance with national standards.
Clinical & Coding Specifications
Clinical Context
A patient is admitted to an inpatient hospital for a surgical procedure involving the upper abdomen, such as a laparoscopic cholecystectomy, appendectomy, or repair of an inguinal hernia. The patient may present with conditions like acute appendicitis, intestinal obstruction, or diverticulosis. An anesthesiology provider administers anesthesia for the intraperitoneal procedure, ensuring patient safety and comfort throughout the surgery. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care.
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 (CRNA) provides anesthesia under the medical direction of a physician.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology Physician |
367H00000X | Anesthesiologist Assistant |
367500000X | Certified Registered Nurse Anesthetist |
These taxonomies represent the specialties eligible to report anesthesia services for intraperitoneal procedures in the upper abdomen.
Related Diagnoses
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K35.80: Acute appendicitis without perforation or gangrene- Relevant for patients undergoing laparoscopic appendectomy, where anesthesia is required for the procedure.
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K40.90: Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent- Pertinent for patients receiving laparoscopic hernia repair, necessitating anesthesia services.
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K56.60: Unspecified intestinal obstruction- Applies to cases where surgical intervention for intestinal obstruction is performed, requiring anesthesia.
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K57.30: Diverticulosis of large intestine without perforation or abscess without bleeding- Relevant for patients undergoing surgical procedures for diverticulosis, with anesthesia provided.
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K63.5: Polyp of colon- Pertinent for patients having surgical removal of colon polyps, where anesthesia is administered.
Each diagnosis represents a clinical scenario where anesthesia for intraperitoneal procedures in the upper abdomen, as described by 00797, may be required.
Related CPT Codes
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47562: Laparoscopy, surgical; cholecystectomy- Used for removal of the gallbladder via laparoscopy. Commonly paired with anesthesia code
00797when performed in the upper abdomen.
- Used for removal of the gallbladder via laparoscopy. Commonly paired with anesthesia code
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44970: Laparoscopy, surgical, appendectomy- Used for removal of the appendix via laparoscopy. Anesthesia for this procedure is reported with
00797.
- Used for removal of the appendix via laparoscopy. Anesthesia for this procedure is reported with
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49650: Laparoscopy, surgical; repair initial inguinal hernia- Used for laparoscopic repair of an inguinal hernia. Anesthesia for this procedure is covered by
00797.
- Used for laparoscopic repair of an inguinal hernia. Anesthesia for this procedure is covered by
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44180: Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion)- Used for laparoscopic removal of intestinal adhesions. Anesthesia for this procedure is reported with
00797.
- Used for laparoscopic removal of intestinal adhesions. Anesthesia for this procedure is reported with
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44204: Laparoscopy, surgical; colectomy, partial, with anastomosis- Used for partial removal of the colon with reconnection. Anesthesia for this procedure is covered by
00797.
- Used for partial removal of the colon with reconnection. Anesthesia for this procedure is covered by
These codes represent the surgical procedures for which anesthesia services described by 00797 are provided. They are commonly used together in the clinical workflow, with 00797 representing the anesthesia component and the others representing the surgical procedure.
National Reimbursement Benchmarks
National mean rates for CPT code 00797 show that Blue Cross Blue Shield and Cigna are the highest among commercial payers, with mean rates of $604.85 and $601.14, respectively. The BUCA average commercial mean rate is $311.33, which is substantially higher than UnitedHealth Group's mean rate of $65.54. Medicare data is not available in the input for comparison.
Rate dispersion varies significantly across payers. UnitedHealth Group has the tightest range, with a difference of $25.35 between the 75th and 25th percentiles, indicating relatively consistent reimbursement. In contrast, Aetna and Cigna display the widest ranges, with differences of $839.00 and $860.50, respectively, reflecting substantial variability in rates. 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 00797, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($387.50), while Aetna, Cigna, and UnitedHealth Group have minimal spreads, indicating consistent rates across providers. Compared to national averages, Alaska's mean rates for Aetna and BUCA are significantly higher, whereas Cigna and UnitedHealth Group are below their national benchmarks. This suggests a unique regional pricing dynamic for certain payers in Alaska.
The table and chart below present the full breakdown of mean rates and percentile values for each payer in Alaska, highlighting the substantial differences in reimbursement across the major commercial insurers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00797 in Alaska, with a mean rate of $749.14.
- UnitedHealth Group offers the lowest mean rate at $75.12.
- Mean rates for Aetna and BUCA in Alaska are notably higher than their respective 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.