Summary & Overview
CPT 00870: Anesthesia for Lower Abdomen Procedures, Cystolithotomy
CPT code 00870 represents anesthesia for extraperitoneal procedures in the lower abdomen, including the urinary tract, with a focus on cystolithotomy. This code is significant in the national healthcare landscape as it addresses the specialized anesthesia care required for surgical removal of bladder stones, a procedure commonly performed in hospital operating rooms. The publication covers key payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer coverage and policy considerations for this code.
Readers will gain insights into the clinical context of 00870, including its role in supporting surgical outcomes and patient safety. The summary also highlights relevant benchmarks and policy updates, offering clarity on how this code is utilized across major insurance providers. Additionally, the publication explores associated modifiers and taxonomies, helping stakeholders understand the nuances of billing and credentialing for anesthesia services. By examining related CPT codes and common ICD-10 diagnoses, the article situates 00870 within the broader framework of lower abdominal and urinary tract procedures, ensuring a well-rounded perspective for healthcare professionals, administrators, and policy analysts.
CPT Code Overview
CPT code 00870 is used to report anesthesia services for extraperitoneal procedures in the lower abdomen, including the urinary tract, specifically for cystolithotomy. This code falls under the anesthesiology service type and is typically performed in a surgical setting, such as a hospital operating room (Place of Service 21). The procedure involves providing anesthesia care to patients undergoing surgical removal of bladder stones, ensuring patient comfort and safety during the operation.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient presenting with urinary tract symptoms such as pain, hematuria, or difficulty urinating. Diagnostic imaging reveals the presence of bladder stones, necessitating a surgical cystolithotomy. The procedure is performed in a hospital operating room (POS 21) under general anesthesia. An anesthesiology provider, such as an anesthesiologist, anesthesiologist assistant, or certified registered nurse anesthetist, administers anesthesia for the extraperitoneal lower abdominal procedure. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative recovery.
Coding Specifications
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Modifiers:
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 under the medical direction of a physician.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
367H00000X | Anesthesiologist Assistant |
367500000X | Certified Registered Nurse Anesthetist |
These taxonomies represent the specialties eligible to provide anesthesia services for this procedure.
Related Diagnoses
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K63.5: Polyp of colon- Relevant when a patient has a colonic polyp identified during evaluation, which may be addressed during lower abdominal surgery.
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K92.2: Gastrointestinal hemorrhage, unspecified- Indicates a patient presenting with GI bleeding, which may necessitate surgical intervention in the lower abdomen.
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D12.6: Benign neoplasm of colon, unspecified- Used when a benign colon tumor is found, potentially requiring surgical management in the lower abdomen.
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K52.9: Noninfective gastroenteritis and colitis, unspecified- Represents inflammation of the colon or GI tract, possibly contributing to symptoms leading to surgical evaluation.
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R19.7: Diarrhea, unspecified- Indicates a symptom that may prompt further investigation and surgical intervention if associated with other findings.
Each diagnosis code reflects conditions that may be present in patients undergoing extraperitoneal lower abdominal procedures, including cystolithotomy.
Related CPT Codes
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00860: Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract. Closely related to00870, often used for similar procedures but not specifically for cystolithotomy. -
00862: Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper one third of ureter, or donor nephrectomy. Used when the procedure involves the upper ureter or kidney, serving as an alternative to00870when the surgical site differs. -
00872: Anesthesia for lithotripsy, extracorporeal shock wave; without water bath. Used for non-invasive stone removal procedures, may be an alternative to cystolithotomy depending on clinical indications. -
00873: Anesthesia for anorectal procedure (Including anorectal endoscopy and/or biopsy). Used for procedures in the anorectal region, not typically performed with cystolithotomy but may be coded together if multiple procedures are performed in the same session.
These codes are related by anatomical site or procedural similarity and may be used as alternatives or in conjunction with 00870 depending on the clinical scenario.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 00870 among BUCA (average commercial) payers is $144.32, which is substantially higher than the UnitedHealth Group mean rate of $65.57. Blue Cross Blue Shield and Cigna report the highest mean rates at $293.53 and $299.27, respectively, while Aetna's mean rate stands at $178.13.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. UnitedHealth Group exhibits the tightest range at $25.00, indicating less variability in contracted rates. In contrast, Cigna shows the widest dispersion at $344.00, followed by Aetna at $275.00, reflecting greater variability in commercial reimbursement. Blue Cross Blue Shield and BUCA also display notable ranges of $185.25 and $172.83, respectively.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a significant spread in reimbursement rates for CPT code 00870, with Blue Cross Blue Shield showing the widest range between the 25th and 75th percentiles ($96.90), while Aetna and UnitedHealth Group have minimal spread ($0 to $4). This indicates that some payers in Alaska maintain consistent rates, while others, like Blue Cross Blue Shield and BUCA, offer a broader range of payments. Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are substantially higher, while Cigna and UnitedHealth Group are closer to or slightly above their national benchmarks.
The table and chart below present the full breakdown of payer-specific reimbursement rates for CPT code 00870 in Alaska, including mean rates and percentile distributions.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00870 in Alaska, with a mean rate of $330.56.
- 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 notably higher than their respective national averages.
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.