Summary & Overview
CPT 00842: Anesthesia for Lower Anterior Abdominal Wall Procedures
Headline: CPT 00842: Anesthesia for Lower Anterior Abdominal Wall Procedures
Lead: CPT 00842 denotes anesthetic services provided for procedures on the lower anterior abdominal wall and is relevant across outpatient surgical settings where hernia repairs and related abdominal wall operations are performed. The code captures the anesthesia component distinct from the surgical procedure and is used by anesthesiology clinicians in perioperative billing.
What this code represents and why it matters: CPT 00842 identifies the anesthetic service for a defined anatomical region, ensuring separation of professional anesthesia work from the surgical procedure code. Nationally, consistent use of the code supports accurate billing, resource allocation, and claims validation for anesthesia teams in ambulatory hospital settings.
Key payers covered: This summary addresses major commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Overview of reader takeaways: Readers will find guidance on clinical context for CPT 00842, typical procedural pairings (such as hernia repairs), common billing modifiers and clinician taxonomies associated with the service, and the relevant ICD-10 diagnostic linkages used to support medical necessity. The publication provides benchmarks and policy context related to coding and payer coverage practices where available, and notes when specific data are not available in the input.
CPT Code Overview
CPT 00842 describes anesthesia for procedures on the lower anterior abdominal wall. This code is used by anesthesia clinicians to report provision of anesthetic care when surgical or procedural interventions target the lower anterior abdominal region. The service type is Anesthesiology and the typical site of service is Outpatient Hospital (POS 22).
Clinical & Coding Specifications
Clinical Context
A typical outpatient adult patient presents for elective repair of a hernia located on the lower anterior abdominal wall (for example, an inguinal, femoral, umbilical, or ventral hernia). The patient is evaluated preoperatively in the outpatient hospital setting (POS 22), reviewed for medical history, allergies, and anesthesia risk. The anesthesia team (anesthesiologist or CRNA) provides an anesthesia plan consistent with the surgical approach (open or laparoscopic hernia repair). Intraoperative management includes induction, maintenance, monitoring of vital signs, airway management as needed, and postoperative emergence and handoff to recovery. Perioperative documentation includes the anesthesia start and stop times, technique, airway device, medications administered, monitoring modalities, and any intraoperative events relevant to the anesthetic for the lower anterior abdominal wall procedure.
Coding Specifications
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Modifiers
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QS- Monitored anesthesia care service. Use when anesthesia is provided as monitored anesthesia care (MAC) rather than general anesthesia, regional block alone, or sedation without anesthesia provider documentation inconsistent with MAC billing. -
QX- CRNA service with medical direction by a physician. Use when a Certified Registered Nurse Anesthetist (CRNA) furnishes the anesthesia service and the service is medically directed by a physician under applicable supervision rules. -
Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|
207L00000X | Anesthesiology Physician |
367500000X | Certified Registered Nurse Anesthetist |
207LA0401X | Pain Medicine (Anesthesiology) |
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Notes on use
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Use
QXwhen CRNA performs the service with documented medical direction by an anesthesiologist per payer rules. -
Use
QSwhen the documented service meets criteria for monitored anesthesia care rather than intraoperative general anesthesia or regional anesthesia coding.
Related Diagnoses
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K40.90— Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent- Clinical relevance: Inguinal hernias are a primary indication for lower anterior abdominal wall operative repair; anesthesia is required for surgical correction.
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K41.90— Unilateral femoral hernia, without obstruction or gangrene, not specified as recurrent- Clinical relevance: Femoral hernias in the lower anterior abdominal wall region are repaired surgically and require anesthesia services corresponding to that anatomic site.
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K42.9— Umbilical hernia without obstruction or gangrene- Clinical relevance: Umbilical hernia repairs involve the lower anterior abdominal wall and are covered by the anesthesia code for that region.
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K43.9— Ventral hernia without obstruction or gangrene- Clinical relevance: Ventral (incisional) hernias of the abdominal wall necessitate operative repair with associated anesthesia services for the affected lower anterior abdominal wall.
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K44.9— Diaphragmatic hernia without obstruction or gangrene- Clinical relevance: Although diaphragmatic hernias are anatomically higher, the provided listing includes this code; when a diaphragmatic hernia procedure requires anesthesia, documentation must support the anesthetic for the specific surgical site and procedure.
Related CPT Codes
| CPT Code | Description |
|---|---|
49505 | Repair initial inguinal hernia, age 5 years or older; reducible |
49585 | Repair umbilical hernia, age 5 years or older; reducible |
49650 | Laparoscopy, surgical; repair initial inguinal hernia |
49560 | Repair initial incisional or ventral hernia; reducible |
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49505relates as the common open surgical procedure for an inguinal hernia; anesthesia for this procedure is reported with the primary anesthesia code for lower anterior abdominal wall procedures. -
49585relates as the common open surgical procedure for umbilical hernia repair; anesthesia for this procedure is reported under the same anesthesia code when the surgical site is the lower anterior abdominal wall. -
49650is a laparoscopic approach to inguinal hernia repair; the anesthesia code for lower anterior abdominal wall procedures applies to both open and laparoscopic approaches, and49650may be used as the operative code in the surgical claim while00842describes the anesthesia service. -
49560is repair of incisional or ventral hernia; when located on the lower anterior abdominal wall, the anesthesia service for this operation is reported with the primary anesthesia code for that anatomic region. -
Common pairings/alternatives: The listed surgical CPT codes are commonly paired with the anesthesia code for lower anterior abdominal wall procedures (
00842) as the corresponding anesthesia service; choice among these surgical codes depends on the specific hernia type, approach (open versus laparoscopic), and intraoperative findings.
National Reimbursement Benchmarks
National mean commercial rates exceed Medicare when compared with BUCA (the average commercial benchmark): the BUCA mean rate is $123.21 while the implied Medicare value is not provided in the input (reported here as $0.00 to indicate no Medicare mean present in the provided data). Blue Cross Blue Shield shows the highest national mean at $281.14, followed by Cigna at $156.99 and Aetna at $145.83; UnitedHealth Group has the lowest reported commercial mean at $65.63.
Rate dispersion, measured as the difference between the 75th and 25th percentiles, is widest for Blue Cross Blue Shield (range $141.97) and Aetna (range $220.00), indicating substantial variability in paid rates. Dispersion is tightest for Cigna (range $13.76) and UnitedHealth Group (range $25.47), reflecting more concentrated rate distributions for those payers. The table and chart below present the full percentile and mean breakdown for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a significant spread in reimbursement rates for CPT code 00842, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $75.38. Aetna and UnitedHealth Group display minimal rate variation, with all percentiles clustered closely around $72, indicating limited negotiation or variation in contracted rates. Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and Aetna are notably higher, while Cigna and UnitedHealth Group are below their respective national means.
The table and chart below present the full breakdown of payer-specific rates for CPT code 00842 in Alaska, highlighting the differences in mean and percentile values across the major commercial payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00842 in Alaska, with a mean rate of $269.45.
- UnitedHealth Group offers the lowest mean rate in Alaska at $75.12.
- Alaska's mean rates for most payers are higher than national averages, except for Cigna and UnitedHealth Group, which are below their respective national means.
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.