Summary & Overview
CPT 00860: Anesthesia for Extraperitoneal Lower Abdominal Procedures
CPT 00860 designates anesthesia services for extraperitoneal procedures in the lower abdomen, including operations involving the urinary tract. This code captures perioperative anesthetic management for a range of lower abdominal surgical procedures and is important for accurate billing, clinical documentation, and appropriate payment across surgical and anesthesia service lines. Nationally, proper use of the code supports clear communication between anesthesia providers, surgeons, and payers and helps ensure the procedural context for anesthetic services is recorded.
Major commercial payers relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of the code’s clinical scope and typical hospital-based sites of service, guidance on common billing modifiers and provider taxonomies associated with anesthesia delivery, examples of common ICD-10 diagnoses paired with the procedure, and a brief comparison to a closely related CPT code (00862).
The publication provides a concise reference for coding and billing teams, anesthesia departments, and practice managers seeking clarity on when CPT 00860 is appropriate, how it relates to ancillary anesthesia services, and what diagnostic contexts commonly accompany its use. Data not available in the input.
CPT Code Overview
CPT 00860 describes anesthesia for extraperitoneal procedures in the lower abdomen, including the urinary tract. This service falls under Anesthesiology and typically applies when anesthesia care is provided for surgeries that access the lower abdominal extraperitoneal space.
The procedure is most commonly billed in hospital operating room settings, including Hospital – Outpatient (POS 22) and Inpatient (POS 21).
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Clinical & Coding Specifications
Clinical Context
A 56-year-old patient presents for surgical repair of a symptomatic right-sided inguinal hernia. The surgical team schedules an open extraperitoneal lower abdominal approach under general anesthesia with regional block as indicated. Preoperative evaluation is performed in the hospital preoperative area; consent is obtained and anesthesia assessment documents airway, comorbidities, and planned anesthetic technique. The patient is transported to the hospital operating room (commonly billed as Hospital – Inpatient POS 21 or Hospital – Outpatient POS 22). Intraoperative management includes induction, airway maintenance, hemodynamic monitoring, fluid management, and perioperative analgesia. The anesthesia service is documented in the anesthesia record and coded using 00860 for anesthesia for extraperitoneal procedures in the lower abdomen, including urinary tract. If a certified registered nurse anesthetist (CRNA) provides the service with physician medical direction, the QX modifier is appended; if monitored anesthesia care is provided instead of general anesthesia, the QS modifier may be applied. Post-anesthesia care occurs in the PACU with handoff to recovery nursing and the surgical team for postoperative orders and disposition.
Coding Specifications
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Modifiers:
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QS: Monitored anesthesia care service. Use when the anesthesia service provided is monitored anesthesia care rather than a general or regional anesthetic for the listed procedure. -
QX: CRNA service with medical direction by a physician. Use when a Certified Registered Nurse Anesthetist delivers the anesthesia service and the physician provides medical direction consistent with applicable payer rules.
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Associated provider taxonomies and specialties:
Taxonomy Code Specialty Name 207L00000XAnesthesiology 367500000XCertified Registered Nurse Anesthetist 207RA0401XAnesthesiology Assistant -
Typical site of service: Hospital operating room settings, most commonly billed as
POS 21(Inpatient) orPOS 22(Outpatient).
Related Diagnoses
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K56.60- Unspecified intestinal obstruction- Clinical relevance: Intestinal obstruction in the lower abdomen can necessitate extraperitoneal surgical approaches and anesthesia services described by
00860when the procedure is confined to the extraperitoneal space.
- Clinical relevance: Intestinal obstruction in the lower abdomen can necessitate extraperitoneal surgical approaches and anesthesia services described by
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K40.90- Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent- Clinical relevance: Inguinal hernia repairs are common extraperitoneal lower abdominal procedures for which
00860is the anesthesia code.
- Clinical relevance: Inguinal hernia repairs are common extraperitoneal lower abdominal procedures for which
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K42.9- Umbilical hernia without obstruction or gangrene- Clinical relevance: Umbilical hernia repair via extraperitoneal technique in the lower abdomen is included in the clinical scenarios covered by
00860.
- Clinical relevance: Umbilical hernia repair via extraperitoneal technique in the lower abdomen is included in the clinical scenarios covered by
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K43.9- Ventral hernia without obstruction or gangrene- Clinical relevance: Ventral hernia repairs involving the lower abdominal extraperitoneal space are procedures for which anesthesia is reported with
00860.
- Clinical relevance: Ventral hernia repairs involving the lower abdominal extraperitoneal space are procedures for which anesthesia is reported with
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K44.9- Diaphragmatic hernia without obstruction or gangrene- Clinical relevance: Diaphragmatic hernia procedures may involve extraperitoneal approaches in the lower abdomen or adjacent regions; when the operative approach fits the
00860descriptor, this diagnosis is relevant to anesthesia coding.
- Clinical relevance: Diaphragmatic hernia procedures may involve extraperitoneal approaches in the lower abdomen or adjacent regions; when the operative approach fits the
Related CPT Codes
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00862- Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper one third of ureter, or donor nephrectomy.-
Relationship to
00860:00862covers a related anatomical region and procedures that extend to renal work or donor nephrectomy; it is used when the anesthetic service is for those renal or upper ureter procedures rather than the lower abdominal extraperitoneal procedures described by00860. -
Clinical workflow note:
00862may be used as an alternative when the operative procedure includes renal components.00860remains the appropriate code for extraperitoneal lower abdominal and urinary tract procedures that do not involve the upper one third of the ureter or donor nephrectomy.
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National Reimbursement Benchmarks
National commercial mean rates for CPT 00860 are higher than the BUCA (average commercial) mean and substantially higher than the UnitedHealth Group mean. BUCA’s mean of $211.13 sits below the major commercial payers (Aetna, Blue Cross Blue Shield, Cigna), which range from $332.99 to $350.71; UnitedHealth Group’s mean of $65.60 is markedly lower than both BUCA and those commercial payers.
Rate dispersion (P75 minus P25) is widest for Aetna and Cigna when considering the absolute spread between their 75th and 25th percentiles, with Aetna showing a range of $483.00 (P75 $525.00 minus P25 $42.00) and Cigna showing $431.00 (P75 $519.00 minus P25 $88.00). Blue Cross Blue Shield has a moderate spread of $202.83, BUCA’s spread is $260.87, and UnitedHealth Group is the tightest with a spread of $25.47. The table and chart below present the full payer breakdown and national mean comparisons.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a wide spread in reimbursement rates for CPT code 00860 among commercial payers. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($536.00 - $324.17 = $211.83), indicating significant variability in negotiated rates. In contrast, Aetna and UnitedHealth Group have minimal spreads ($0.00 and $4.00, respectively), suggesting more uniform payment structures. Cigna's spread is also low at $8.00.
Compared to national averages, Blue Cross Blue Shield in Alaska pays notably higher mean rates, while Cigna and UnitedHealth Group reimburse at much lower levels than their national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these disparities.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00860 in Alaska, with a mean rate of $419.02.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both state and national averages.
- Cigna's mean rate in Alaska ($89.33) is much lower than its national mean ($350.71), indicating a substantial deviation.
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