Summary & Overview
CPT 00916: Anesthesia for Urinary System Bleeding Procedures with Endoscope
CPT code 00916 covers anesthesia for procedures to control urinary system bleeding, including the use of an endoscope. This code is significant for hospitals and surgical centers nationwide, as it addresses a critical aspect of patient care during urological interventions. The publication provides a comprehensive overview of the clinical context, typical sites of service, and the role of anesthesia in these procedures. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting broad national coverage.
Readers will gain insights into the clinical indications for the use of CPT code 00916, common billing practices, and relevant policy updates. The summary also highlights associated modifiers and taxonomies, as well as related CPT codes and ICD-10 diagnoses that may be encountered in practice. This resource is designed to inform healthcare professionals, billing specialists, and policy analysts about the benchmarks and regulatory considerations for anesthesia services in urological procedures. The information is organized to support accurate coding, compliance, and understanding of payer requirements across the United States.
CPT Code Overview
CPT code 00916 is used to report anesthesia services for procedures aimed at controlling bleeding within the urinary system, including those performed with an endoscope. This code falls under the Anesthesiology service type and is typically utilized in hospital inpatient or outpatient settings, such as a surgical suite (Place of Service 21 or 22). The procedure requires specialized anesthesia care to ensure patient safety and comfort during interventions to manage urinary tract bleeding.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a patient admitted to the hospital with active urinary system bleeding, such as hematuria due to trauma, tumor, or post-surgical complications. The patient requires a procedure to control the bleeding, which is performed using an endoscope. An anesthesiologist or CRNA provides anesthesia services to ensure patient comfort and safety during the endoscopic intervention. The procedure is commonly performed in a hospital inpatient or outpatient surgical suite.
Coding Specifications
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Modifiers:
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QS: Monitored anesthesia care service. Used when the anesthesia provider is present and monitoring the patient, but not providing general anesthesia. -
QX: CRNA service with medical direction by a physician. Used when a Certified Registered Nurse Anesthetist (CRNA) provides the anesthesia service under the medical direction of a physician.
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Provider Taxonomies:
Taxonomy Code Specialty 207R00000XAnesthesiology 208600000XPain Medicine
These taxonomies represent providers specializing in anesthesia and pain management.
Related Diagnoses
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M23.50: Chronic instability of knee, unspecified knee- Relevant when a patient has chronic knee instability, which may be a comorbidity affecting anesthesia risk assessment.
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M25.561: Pain in right knee- Indicates pain in the right knee, potentially relevant for preoperative evaluation or comorbidity documentation.
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M25.562: Pain in left knee- Indicates pain in the left knee, similarly relevant for preoperative assessment.
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M17.11: Unilateral primary osteoarthritis, right knee- Represents osteoarthritis in the right knee, which may impact anesthesia planning due to mobility or positioning concerns.
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M17.12: Unilateral primary osteoarthritis, left knee- Represents osteoarthritis in the left knee, also relevant for anesthesia considerations.
These diagnoses are not directly related to the urinary system procedure but may be documented as comorbidities affecting anesthesia management.
Related CPT Codes
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00914: Anesthesia for removal of prostate including use of an endoscope. This code is used when anesthesia is provided for endoscopic prostate removal procedures. It is related to00916as both involve anesthesia for endoscopic procedures in the urinary system. -
00918: Anesthesia for fragmenting, manipulation and/or removal of kidney stone including use of an endoscope. This code is used for anesthesia during endoscopic kidney stone procedures. It is related to00916as both involve anesthesia for endoscopic interventions in the urinary tract.
These codes may be used as alternatives depending on the specific urinary system procedure performed. They are not typically billed together but are part of the same clinical workflow family.
National Reimbursement Benchmarks
National mean rates for CPT code 00916 show that Cigna and Blue Cross Blue Shield have the highest average reimbursement, at $298.27 and $265.84 respectively, while UnitedHealth Group is notably lower at $65.57. The BUCA (average commercial) mean rate stands at $135.67, which is substantially higher than typical Medicare rates for similar codes, though Medicare-specific data is not available in the input.
Rate dispersion varies significantly across payers. UnitedHealth Group has the tightest range between the 25th and 75th percentiles ($25.46), indicating less variability in contracted rates. In contrast, Cigna exhibits the widest spread ($345.00), reflecting greater variability in reimbursement. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a significant spread in reimbursement rates for CPT code 00916, particularly among commercial payers. Blue Cross Blue Shield shows the widest rate spread, with a 75th percentile of $371.50 and a 25th percentile of $274.60, resulting in a $96.90 difference. BUCA also exhibits a substantial spread of $159.50 between its 75th and 25th percentiles. In contrast, Aetna and UnitedHealth Group have minimal rate variation, with all percentiles clustered closely around $72.00, indicating little negotiation or variation in rates for these payers.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably 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 00916 in Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00916 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 are notably higher than national averages, especially for Blue Cross Blue Shield and BUCA.
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.