Summary & Overview
CPT 00862: Anesthesia for Lower Abdomen and Renal Procedures
CPT code 00862 covers anesthesia services for lower abdominal procedures, specifically those involving the urinary tract and renal operations such as upper ureter interventions or donor nephrectomy. This code is significant for hospitals and surgical facilities, as it applies to both inpatient and outpatient settings where complex abdominal and renal surgeries are performed. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage for these essential anesthesia services.
This publication provides a comprehensive overview of CPT code 00862, detailing its clinical context, typical sites of service, and payer coverage. Readers will gain insight into the types of procedures associated with this code, relevant policy updates, and benchmarks for anesthesia billing. The summary also highlights common modifiers and associated taxonomies, offering clarity on how anesthesia services are documented and reimbursed. By understanding the scope and application of CPT code 00862, stakeholders can better navigate the complexities of medical billing and policy for anesthesia in abdominal and renal procedures.
CPT Code Overview
CPT code 00862 is used to report anesthesia services for procedures performed in the lower abdomen (extraperitoneal), including the urinary tract. This includes renal procedures such as operations on the upper one third of the ureter or donor nephrectomy. The service type is anesthesia, and these procedures are typically performed in a hospital or surgical facility, which may be an inpatient or outpatient surgical setting.
Clinical & Coding Specifications
Clinical Context
A patient is admitted to a hospital or surgical facility for a renal procedure involving the upper one third of the ureter or a donor nephrectomy. The patient may present with conditions such as unspecified intestinal obstruction, polyp of colon, diverticulosis of the large intestine without perforation or abscess, peritonitis, or hemoperitoneum. The surgical team schedules the procedure, and anesthesia services are provided specifically for extraperitoneal lower abdominal surgery, including the urinary tract. Anesthesia is administered by an anesthesiologist, certified registered nurse anesthetist, or anesthesiology assistant, depending on the staffing and medical direction requirements. The workflow includes preoperative assessment, induction and maintenance of anesthesia during the procedure, and postoperative monitoring in the recovery area.
Coding Specifications
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Modifiers:
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QS: Monitored anesthesia care service. Used when the anesthesia provider is delivering monitored anesthesia care rather than general anesthesia. -
QX: CRNA service with medical direction by a physician. Used when a Certified Registered Nurse Anesthetist is providing anesthesia services under the medical direction of a physician.
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Provider Taxonomies:
| Taxonomy Code | Specialty Description |
|---|---|
207L00000X | Anesthesiology |
367500000X | Certified Registered Nurse Anesthetist |
207RA0401X | Anesthesiology Assistant |
These taxonomies represent the specialties eligible to provide anesthesia services for procedures described by CPT code 00862.
Related Diagnoses
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K56.60: Unspecified intestinal obstruction- Relevant when the patient presents with an obstruction requiring surgical intervention in the lower abdomen, potentially involving the urinary tract.
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K63.5: Polyp of colon- May necessitate surgical removal in the lower abdomen, requiring anesthesia services as described by CPT code
00862.
- May necessitate surgical removal in the lower abdomen, requiring anesthesia services as described by CPT code
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K57.30: Diverticulosis of large intestine without perforation or abscess- Indicates a condition that may require surgical management in the lower abdomen, with anesthesia support.
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K65.9: Peritonitis, unspecified- Represents inflammation of the peritoneum, which may lead to surgical intervention in the lower abdomen and require anesthesia services.
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K66.1: Hemoperitoneum- Presence of blood in the peritoneal cavity may necessitate urgent surgical procedures in the lower abdomen, with anesthesia services provided as per CPT code
00862.
- Presence of blood in the peritoneal cavity may necessitate urgent surgical procedures in the lower abdomen, with anesthesia services provided as per CPT code
Related CPT Codes
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49505: Repair initial inguinal hernia, age 5 years or older- This code represents a surgical procedure in the lower abdomen, which may require anesthesia services similar to those described by CPT code
00862.
- This code represents a surgical procedure in the lower abdomen, which may require anesthesia services similar to those described by CPT code
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44120: Enterectomy, resection of small intestine- This procedure involves resection of the small intestine and may be performed in the lower abdomen, necessitating anesthesia services as per CPT code
00862.
- This procedure involves resection of the small intestine and may be performed in the lower abdomen, necessitating anesthesia services as per CPT code
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44140: Colectomy, partial; with anastomosis- Partial colectomy with anastomosis is a lower abdominal surgery that may require anesthesia services covered by CPT code
00862.
- Partial colectomy with anastomosis is a lower abdominal surgery that may require anesthesia services covered by CPT code
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49000: Exploratory laparotomy, exploratory celiotomy- Exploratory laparotomy is a surgical exploration of the abdominal cavity, often performed in cases of acute abdominal conditions. Anesthesia services for this procedure may be coded with CPT code
00862when performed in the lower abdomen (extraperitoneal).
- Exploratory laparotomy is a surgical exploration of the abdominal cavity, often performed in cases of acute abdominal conditions. Anesthesia services for this procedure may be coded with CPT code
These codes are commonly used together in surgical workflows when multiple procedures are performed in the lower abdomen, or as alternatives depending on the specific surgical indication.
National Reimbursement Benchmarks
For CPT code 00862, national mean rates among commercial payers show significant variation. The BUCA (average commercial) mean rate is $227.14, while UnitedHealth Group is notably lower at $65.57. In contrast, Aetna, Blue Cross Blue Shield, and Cigna report much higher mean rates, with Cigna at $403.25 and Aetna at $387.32. Medicare data is not available in the input.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies widely across payers. UnitedHealth Group has the tightest range ($25.30), indicating less variability in rates, while Aetna ($531.00) and Cigna ($519.67) exhibit the widest spreads. Blue Cross Blue Shield and BUCA show moderate dispersion, at $179.00 and $271.50 respectively.
The table and chart below present the full breakdown of national benchmarks for CPT code 00862 by payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska displays a wide rate spread for CPT code 00862, particularly with Blue Cross Blue Shield, where the 75th percentile ($620.25) is substantially higher than the 25th percentile ($372.14), resulting in a spread of $248.11. Other payers, such as Aetna, Cigna, and UnitedHealth Group, show much narrower spreads, with their 25th and 75th percentiles differing by only a few dollars. This indicates that Blue Cross Blue Shield has both the highest rates and the greatest variability among payers in Alaska.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and Aetna are notably higher, while Cigna and UnitedHealth Group are closer to national levels. The table and chart below present the full breakdown of payer-specific reimbursement rates in Alaska for CPT code 00862.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00862 in Alaska, with a mean rate of $484.89.
- UnitedHealth Group offers the lowest mean rate at $75.12.
- Alaska's mean rates for most payers are significantly higher than national averages, especially for Blue Cross Blue Shield and Aetna.
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.