Summary & Overview
CPT 00918: Anesthesia for Stone Removal Procedures
CPT code 00918 represents anesthesia services provided during stone removal procedures, a critical component in surgical care for patients with urinary or genital stones. This code is widely recognized across the United States and is used by providers to document and bill for anesthesia care in outpatient hospital settings. The publication covers key payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, offering a comprehensive overview of payer coverage and policy considerations for this code.
Readers will gain insight into the clinical context of stone removal anesthesia, typical sites of service, and relevant billing practices. The summary includes information on common modifiers, associated provider taxonomies, and ICD-10 diagnoses frequently linked to stone removal procedures. Additionally, related CPT codes for anesthesia in similar anatomical regions are discussed, providing a broader understanding of coding practices in urologic and genital surgeries. This resource is designed to inform healthcare professionals, billing specialists, and policy analysts about current benchmarks, policy updates, and clinical nuances associated with CPT 00918.
CPT Code Overview
CPT 00918 is designated for anesthesia services related to stone removal procedures. This code is used to report the administration of anesthesia during surgical interventions aimed at removing stones, typically within the urinary tract or genital organs. The service type is anesthesia, and the typical site of service is an outpatient hospital setting (POS 22). This code is essential for accurately documenting and billing anesthesia care provided during stone removal surgeries, ensuring proper reimbursement and compliance with national billing standards.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient hospital with symptoms related to a disorder of the male genital organs, such as phimosis, balanitis, or unspecified inflammation. The urologist determines that stone removal is necessary, which may involve the bladder, urethra, or other parts of the lower urinary tract. An anesthesia provider, such as an anesthesiologist or certified registered nurse anesthetist (CRNA), administers anesthesia to ensure patient comfort and safety during the stone removal procedure. The clinical workflow includes preoperative assessment, anesthesia induction, monitoring throughout the procedure, and postoperative recovery.
Coding Specifications
| Modifier Code | Description | When Used |
|---|---|---|
QS | Monitored anesthesia care service | Used when the anesthesia provider delivers monitored anesthesia care (MAC) during the procedure. |
QX | CRNA service with medical direction by a physician | Used when a CRNA provides anesthesia services under the medical direction of a physician. |
Provider Taxonomies:
207L00000X— Anesthesiology (Physicians specializing in anesthesia)367500000X— Certified Registered Nurse Anesthetist (CRNA)207LA0401X— Pain Medicine (Anesthesiology) (Physicians specializing in pain management within anesthesiology)
Related Diagnoses
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N50.9— Disorder of male genital organs, unspecified- Relevant for patients presenting with non-specific symptoms affecting the male genital organs, which may necessitate stone removal.
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N76.89— Other specified inflammation of vagina and vulva- Included for completeness; may be relevant in rare cases where stone removal involves female genitalia.
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N47.1— Phimosis- Phimosis can lead to urinary complications and may require stone removal procedures.
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N48.1— Balanitis- Balanitis may be associated with infection or inflammation that complicates stone removal.
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N49.9— Inflammatory disorder of male genital organ, unspecified- Used when inflammation is present and stone removal is indicated as part of the treatment plan.
Related CPT Codes
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00910— Anesthesia for procedures on male genitalia- Used for anesthesia services during surgical procedures involving the male genitalia. May be an alternative to
00918if the procedure is not stone removal.
- Used for anesthesia services during surgical procedures involving the male genitalia. May be an alternative to
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00920— Anesthesia for procedures on the perineum, perianal area- Used when anesthesia is required for procedures in the perineal or perianal region. May be used in cases where stone removal involves these areas.
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00921— Anesthesia for procedures on the perineum, perianal area, with rectal involvement- Used when the procedure involves both the perineal/perianal area and the rectum. May be an alternative if stone removal extends to rectal involvement.
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00924— Anesthesia for procedures on the perineum, perianal area, with urethral involvement- Used when the procedure involves the perineal/perianal area and the urethra. May be used together with or as an alternative to
00918if stone removal involves the urethra.
- Used when the procedure involves the perineal/perianal area and the urethra. May be used together with or as an alternative to
These codes are related by anatomical site and procedural complexity. Selection depends on the specific clinical scenario and surgical approach.
National Reimbursement Benchmarks
National mean rates for CPT code 00918 show that commercial payers such as Aetna, Blue Cross Blue Shield, Cigna, and BUCA (average commercial) reimburse at significantly higher levels than UnitedHealth Group. The mean rate for BUCA is $179.44, while UnitedHealth Group is much lower at $65.62. Medicare data is not available in the input, so a direct comparison is not possible.
Rate dispersion varies notably across payers. Aetna exhibits the widest spread, with a difference of $415.30 between the 75th and 25th percentiles, indicating substantial variability in contracted rates. Blue Cross Blue Shield and Cigna also show considerable dispersion, at $163.89 and $344.00 respectively. UnitedHealth Group has the tightest range, with only $25.44 separating the 75th and 25th percentiles, suggesting more consistent rates.
The table and chart below present a detailed breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska displays a wide spread in reimbursement rates for CPT code 00918, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($96.90), while Aetna, Cigna, and UnitedHealth Group have much narrower spreads (all under $30). This indicates that Blue Cross Blue Shield's rates are not only the highest on average but also more variable compared to other payers in the state.
Compared to national averages, Blue Cross Blue Shield and BUCA rates in Alaska are notably higher, while Cigna and UnitedHealth Group are well below their national means. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these differences and the overall distribution across the major commercial payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00918 in Alaska, with a mean rate of $330.33.
- UnitedHealth Group is the lowest paying payer, with a mean rate of $75.12.
- Cigna and UnitedHealth Group rates in Alaska are significantly below their respective national averages, while Blue Cross Blue Shield rates are notably higher than the national mean.
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.