Summary & Overview
CPT 00906: Anesthesia for Perineal Procedures, Not Otherwise Specified
CPT code 00906 covers anesthesia for procedures on the perineum that are not otherwise specified, providing a critical billing option for anesthesiology services in cases where more specific codes do not apply. This code is relevant for a variety of clinical scenarios, including pain management and surgical interventions involving the perineal region. Nationally, the code is recognized by major commercial payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage for outpatient hospital procedures.
Readers will gain insight into the clinical context of 00906, including its typical use in outpatient hospital settings and its role within the broader anesthesiology service line. The publication also highlights associated modifiers, relevant taxonomies, and common ICD-10 diagnoses linked to perineal procedures. Additionally, comparisons to related CPT codes provide clarity on when 00906 should be used versus other anesthesia codes. Policy updates and reimbursement benchmarks are discussed to inform stakeholders about current trends and payer requirements. This summary serves as a comprehensive resource for understanding the national landscape of anesthesia billing for perineal procedures.
CPT Code Overview
CPT code 00906 is used to report anesthesia services for procedures performed on the perineum 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 designed to capture anesthesia care for a range of perineal procedures where no more specific anesthesia code applies.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with pelvic or perineal pain, inflammation, or other disorders affecting the perineal region. The clinical workflow involves preoperative assessment by an anesthesiologist or certified registered nurse anesthetist (CRNA), followed by administration of anesthesia for a surgical or diagnostic procedure on the perineum. The procedure is not otherwise specified, meaning it does not fall under more specific CPT codes for perineal or genital procedures. The anesthesia provider monitors the patient throughout the procedure, ensuring safety and comfort, and may use monitored anesthesia care or provide anesthesia under medical direction.
Coding Specifications
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Modifiers:
Modifier Code Description QSMonitored anesthesia care service QXCRNA service with medical direction by a physician - Modifier
QSis used when the anesthesia service is provided as monitored anesthesia care. - Modifier
QXis used when a CRNA provides the anesthesia service under the medical direction of a physician.
- Modifier
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology 367500000XCertified Registered Nurse Anesthetist 207LA0401XPain Medicine (Anesthesiology) - Anesthesiology (
207L00000X): Physicians specializing in anesthesia. - Certified Registered Nurse Anesthetist (
367500000X): CRNAs providing anesthesia care. - Pain Medicine (Anesthesiology) (
207LA0401X): Anesthesiologists with a focus on pain management.
- Anesthesiology (
Related Diagnoses
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N50.9- Disorder of male genital organs, unspecified- Relevant for patients with undiagnosed or unspecified disorders of the male genitalia requiring perineal procedures.
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N76.89- Other specified inflammation of vagina and vulva- Applies to patients with inflammation in the female genital region, potentially necessitating perineal intervention.
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R10.2- Pelvic and perineal pain- Indicates pain localized to the pelvic or perineal area, often prompting procedures requiring anesthesia.
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N47.1- Phimosis- Refers to a condition affecting the foreskin of the penis, which may require perineal procedures under anesthesia.
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N48.1- Balanitis- Inflammation of the glans penis, possibly leading to perineal procedures requiring anesthesia.
Related CPT Codes
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00902- Anesthesia for procedures on male genitalia- Used for anesthesia services specifically for procedures involving male genital organs. May be an alternative to
00906if the procedure is limited to male genitalia.
- Used for anesthesia services specifically for procedures involving male genital organs. May be an alternative to
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00904- Anesthesia for procedures on the perineum- Used for anesthesia services for perineal procedures. May overlap with
00906but is more specific;00906is used when the procedure is not otherwise specified.
- Used for anesthesia services for perineal procedures. May overlap with
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00908- Anesthesia for radical perineal procedures- Used for more extensive or radical perineal surgeries. Not commonly used together with
00906, but may be selected based on procedure complexity.
- Used for more extensive or radical perineal surgeries. Not commonly used together with
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01992- Anesthesia for diagnostic or therapeutic nerve blocks- Used when anesthesia is provided for nerve block procedures, which may be performed for pain management in the perineal region. Can be used in conjunction with
00906if nerve blocks are part of the procedure.
- Used when anesthesia is provided for nerve block procedures, which may be performed for pain management in the perineal region. Can be used in conjunction with
National Reimbursement Benchmarks
National mean rates for CPT code 00906 show significant variation between commercial payers and Medicare. The average commercial rate (BUCA) is $134.39, while UnitedHealth Group (UHC), which is used as a proxy for Medicare in this context, has a mean rate of $65.57. This indicates that commercial payers generally reimburse at higher levels than Medicare.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies notably across payers. Blue Cross Blue Shield exhibits the tightest range ($314.00 - $168.75 = $145.25), while Cigna has the widest ($348.00 - $90.00 = $258.00). Aetna and BUCA also show substantial spreads, suggesting considerable variability in contracted rates. UnitedHealth Group has the smallest dispersion ($75.33 - $50.33 = $25.00), indicating more consistent reimbursement levels.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a wide spread in reimbursement rates for CPT code 00906, with Blue Cross Blue Shield offering the highest mean rate at $269.25 and UnitedHealth Group the lowest at $75.12. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($74.20), indicating significant variability in payments, while Aetna and UnitedHealth Group have minimal spreads ($0.00 and $4.00, respectively), suggesting more uniform rates. Cigna also displays a narrow spread ($8.00).
Compared to national averages, Alaska's mean rates for Aetna and Blue Cross Blue Shield are notably higher, while Cigna and UnitedHealth Group are below their respective national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska for CPT code 00906.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00906 in Alaska, with a mean rate of $269.25.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
- Alaska's mean rates for most payers are higher than national benchmarks, except for Cigna and UnitedHealth Group, which are notably lower.
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.