Summary & Overview
CPT 00904: Anesthesia for Male Genitalia Procedures
CPT code 00904 represents anesthesia services for procedures on male genitalia, including open urethral procedures not otherwise specified. This code is significant for hospitals and anesthesia providers nationwide, as it ensures proper billing and reimbursement for a variety of surgical interventions involving the male genitalia. The code is most frequently used in outpatient hospital settings, reflecting the trend toward ambulatory surgical care.
Major national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides an overview of payer coverage, typical clinical scenarios, and relevant policy updates. Readers will gain insight into the clinical context for the use of 00904, including common diagnoses such as phimosis, paraphimosis, balanitis, benign prostatic hyperplasia with lower urinary tract symptoms, and inflammatory disorders of the penis. The summary also highlights related CPT codes for procedures commonly associated with anesthesia services under 00904.
This article offers benchmarks for utilization, discusses modifier usage, and outlines associated provider taxonomies. It is designed to inform healthcare professionals, billing specialists, and policy analysts about the key aspects of anesthesia billing for male genital procedures, supporting accurate coding and compliance with payer requirements.
CPT Code Overview
CPT code 00904 is used to report anesthesia services for procedures performed on male genitalia, including open urethral procedures that are not otherwise specified. This code falls under the Anesthesiology service type and is most commonly utilized in the Outpatient Hospital setting (Place of Service 22). The code is essential for accurately documenting and billing anesthesia care provided during a range of surgical interventions involving the male genitalia.
Clinical & Coding Specifications
Clinical Context
A male patient presents to the outpatient hospital with a urological condition such as phimosis, paraphimosis, balanitis, benign prostatic hyperplasia with lower urinary tract symptoms, or an inflammatory disorder of the penis. The patient is scheduled for a surgical procedure on the male genitalia, which may include open urethral procedures. An anesthesiologist provides anesthesia services to ensure patient comfort and safety during the operation. The procedure is performed in an outpatient setting, and the patient is typically healthy, as indicated by modifier P1. Monitored anesthesia care may be provided, as indicated by modifier QS.
Coding Specifications
-
Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesiologist provides monitoring and support during the procedure, rather than full general anesthesia.P1: A normal healthy patient. Indicates the patient has no systemic disease and is classified as ASA Physical Status 1.
-
Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
| 207L00000X | Anesthesiology |
| 207LA0401X | Pain Medicine (Anesthesiology) |
| 207LP2900X | Pediatric Anesthesiology |
- Specialties Represented:
- Anesthesiology: General anesthesia services.
- Pain Medicine (Anesthesiology): Focuses on pain management during procedures.
- Pediatric Anesthesiology: Provides anesthesia care for pediatric patients undergoing genital procedures.
Related Diagnoses
-
N47.1: Phimosis- Phimosis is a condition where the foreskin cannot be retracted over the glans penis. Surgical intervention may require anesthesia as described by
00904.
- Phimosis is a condition where the foreskin cannot be retracted over the glans penis. Surgical intervention may require anesthesia as described by
-
N47.2: Paraphimosis- Paraphimosis occurs when the foreskin is trapped behind the glans and cannot be returned to its normal position, often necessitating surgical correction under anesthesia.
-
N48.1: Balanitis- Balanitis is inflammation of the glans penis, which may require surgical procedures and anesthesia if severe or recurrent.
-
N40.1: Benign prostatic hyperplasia with lower urinary tract symptoms- BPH with LUTS may lead to procedures on the prostate or urethra, requiring anesthesia services.
-
N49.0: Inflammatory disorders of the penis- Inflammatory conditions of the penis may necessitate surgical intervention and anesthesia.
Related CPT Codes
-
54150: Circumcision, using clamp or other device- Used for circumcision procedures, which may require anesthesia as described by
00904.
- Used for circumcision procedures, which may require anesthesia as described by
-
54160: Circumcision, surgical excision other than clamp, device or dorsal slit- Alternative circumcision technique, also requiring anesthesia services.
-
54235: Removal of penile prosthesis- Surgical removal of a penile prosthesis, often performed under anesthesia.
-
55700: Biopsy, prostate; needle or punch, single or multiple, any approach- Prostate biopsy procedures may involve anesthesia for patient comfort.
Clinical Workflow Relation:
- These codes represent surgical procedures on male genitalia or related structures. Anesthesia code
00904is commonly used in conjunction with these procedures to document the anesthesia services provided. 54150and54160are alternatives for circumcision, while54235and55700are distinct procedures that may require anesthesia.
National Reimbursement Benchmarks
National mean rates for CPT code 00904 show significant variation between payers. The average commercial rate (BUCA) is $197.44, while UnitedHealth Group (UHC) is notably lower at $65.60. Blue Cross Blue Shield and Cigna have the highest mean rates at $376.76 and $403.06, respectively. Aetna's mean rate is $284.16.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Cigna ($519.50) and Aetna ($424.00), indicating substantial variability in contracted rates. UnitedHealth Group has the tightest range ($25.47), suggesting more consistent reimbursement levels. Blue Cross Blue Shield and BUCA also show moderate dispersion.
The table and chart below present a detailed breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide rate spread for CPT code 00904, particularly among commercial payers. Blue Cross Blue Shield shows the largest spread, with a 75th percentile rate of $626.67 and a 25th percentile of $372.50, resulting in a difference of $254.17. BUCA also demonstrates significant variability, with a spread of $274.42 between its 75th and 25th percentiles. In contrast, Aetna, Cigna, and UnitedHealth Group have much narrower spreads, all under $5.00, indicating more consistent reimbursement rates within those payers.
When compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably 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 in Alaska, highlighting the substantial differences in reimbursement across the major payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00904 in Alaska, with a mean rate of $485.39, while UnitedHealth Group is the lowest at $75.12.
- The rate spread in Alaska is substantial, with BCBS's 75th percentile ($626.67) far exceeding the lowest 25th percentiles, indicating significant variability across payers.
- Compared to national averages, BCBS and BUCA mean rates in Alaska are notably higher, while Cigna and UnitedHealth Group 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.