Summary & Overview
CPT 00902: Anesthesia for Perineal Procedures, Not Otherwise Specified
CPT code 00902 covers anesthesia for perineal procedures that are not otherwise specified, playing a vital role in surgical care across outpatient hospital settings. This code is relevant for a variety of clinical scenarios where anesthesia is required for interventions involving the perineum, and it is commonly billed by anesthesiology and pain medicine specialists. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage for patients undergoing these procedures.
The publication provides a comprehensive overview of 00902, including payer coverage, typical clinical indications, and associated billing modifiers. Readers will gain insight into the clinical context for use of this code, common diagnoses such as urethrocele and uterovaginal prolapse, and related CPT codes for similar procedures. The analysis also highlights policy updates and benchmarks relevant to anesthesia billing, offering clarity on how this code fits within broader reimbursement and compliance frameworks. This summary is intended for healthcare administrators, billing professionals, and clinicians seeking to understand the national landscape for anesthesia services in perineal procedures.
CPT Code Overview
CPT code 00902 is designated for anesthesia services provided during perineal procedures that are not otherwise specified. This code is typically utilized in the context of outpatient hospital settings (Place of Service 22), where specialized anesthesia care is required for a range of perineal interventions. The service type is anesthesia, reflecting the critical role of anesthesiology professionals in ensuring patient comfort and safety during these procedures. This code serves as a catch-all for perineal procedures that do not fall under more specific anesthesia codes.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient hospital setting with a perineal condition such as a urethrocele, incomplete uterovaginal prolapse, or vaginal enterocele. The patient is scheduled for a perineal surgical procedure that does not fall under more specific anesthesia codes. An anesthesiologist or pain medicine specialist provides anesthesia services for the procedure, ensuring patient comfort and safety throughout the operation. The workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative recovery. The procedure is typically performed on patients who are otherwise healthy, as indicated by modifier P1.
Coding Specifications
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Modifiers:
Modifier Code Description Usage QSMonitored anesthesia care service Used when anesthesia is provided as monitored anesthesia care rather than general anesthesia. P1A normal healthy patient Indicates the patient has no systemic disease and is otherwise healthy. -
Provider Taxonomies:
Taxonomy Code Specialty 207L00000XAnesthesiology 207LA0401XPain Medicine (Anesthesiology) 207LP2900XPediatric Anesthesiology
These taxonomies represent providers specializing in anesthesia, pain management, and pediatric anesthesia.
Related Diagnoses
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N81.0- Urethrocele- Relevant for perineal procedures addressing urethral prolapse or bulging.
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N81.2- Incomplete uterovaginal prolapse- Indicates partial prolapse of the uterus and vagina, often requiring perineal surgical intervention.
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N81.4- Uterovaginal prolapse, unspecified- Used when the type of uterovaginal prolapse is not specified, but perineal surgery is indicated.
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N82.1- Vaginal enterocele- Refers to herniation of the vaginal wall, commonly treated with perineal procedures.
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N99.89- Other postprocedural complications and disorders of genitourinary system- Used for patients experiencing complications after prior genitourinary procedures, necessitating further perineal surgery.
Related CPT Codes
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00910- Anesthesia for transurethral procedures- Used for anesthesia during procedures involving the urethra. May be an alternative to
00902if the procedure is specifically transurethral.
- Used for anesthesia during procedures involving the urethra. May be an alternative to
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00920- Anesthesia for procedures on male genitalia- Used for anesthesia during surgical procedures on male genitalia. Related to
00902but specific to male anatomy.
- Used for anesthesia during surgical procedures on male genitalia. Related to
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00930- Anesthesia for procedures on perineum- Used for anesthesia during perineal procedures. May overlap with
00902but is more specific to perineal surgeries.
- Used for anesthesia during perineal procedures. May overlap with
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00932- Anesthesia for rectal procedures- Used for anesthesia during rectal surgeries. Related to
00902when the procedure involves the rectal area.
- Used for anesthesia during rectal surgeries. Related to
These codes are commonly used as alternatives or in conjunction with 00902 depending on the exact anatomical site and procedure performed.
National Reimbursement Benchmarks
National mean rates for CPT code 00902 show that Blue Cross Blue Shield, Cigna, and Aetna all reimburse at similar levels, with mean rates around $287–$300. UnitedHealth Group is notably lower, with a mean rate of $65.57. The BUCA average commercial benchmark is $185.83, which is substantially higher than UnitedHealth Group but lower than the other major commercial payers. Medicare data is not available in the input.
Rate dispersion varies significantly across payers. Blue Cross Blue Shield has the tightest range between the 25th and 75th percentiles ($157.93), indicating more consistent reimbursement. Aetna displays the widest dispersion ($426.00), suggesting greater variability in rates. Cigna and BUCA also show substantial ranges, while UnitedHealth Group's rates are tightly clustered ($25.30).
The table and chart below present the full breakdown of national benchmarks for CPT code 00902 by payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a significant rate spread for CPT code 00902 across commercial payers. Blue Cross Blue Shield shows the widest spread, with a 75th percentile rate of $371.50 and a 25th percentile rate of $274.60, resulting in a $96.90 difference. Aetna, Cigna, and UnitedHealth Group all have much narrower spreads, with their 25th and 75th percentiles differing by less than $5.00. This indicates that Blue Cross Blue Shield's rates are both higher and more variable compared to other payers in the state.
Compared to national averages, Alaska's mean rates for Aetna and Blue Cross Blue Shield are substantially higher, while Cigna and UnitedHealth Group are below their national benchmarks. The table and chart below present the full breakdown of payer rates for CPT code 00902 in Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00902 in Alaska, with a mean rate of $330.26.
- UnitedHealth Group is the lowest paying payer, with a mean rate of $75.12.
- Mean rates for Aetna and Blue Cross Blue Shield in Alaska are notably higher than their respective national averages, while Cigna and UnitedHealth Group are below national benchmarks.
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