Summary & Overview
CPT 00924: Anesthesia for Undescended Testis Procedures
CPT code 00924 represents anesthesia for procedures on an undescended testis, a condition commonly addressed in pediatric and adult urology. This code is essential for accurately billing and documenting anesthesia services provided during surgical correction of undescended testis, which can impact patient outcomes and long-term health. The code is most frequently utilized in hospital inpatient settings, reflecting the complexity and clinical importance of these procedures.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, recognize and reimburse for CPT code 00924. Understanding payer coverage and policy nuances is crucial for providers and billing professionals to ensure compliance and optimize reimbursement. This publication offers a comprehensive overview of payer coverage, typical modifiers, and associated taxonomies relevant to anesthesia for undescended testis procedures.
Readers will gain insights into clinical benchmarks, policy updates, and the broader context of anesthesia billing for genitourinary surgical interventions. The summary also highlights related CPT codes and ICD-10 diagnoses commonly associated with these procedures, providing a well-rounded perspective for stakeholders in anesthesiology and hospital billing.
CPT Code Overview
CPT code 00924 is used to report anesthesia services for procedures involving an undescended testis, whether on one or both sides. This code falls under the anesthesiology service type and is typically performed in a hospital inpatient setting (Place of Service 21). The procedure is clinically significant as it addresses surgical interventions for undescended testis, a condition that can have implications for patient health and future fertility. Anesthesia is a critical component in ensuring patient comfort and safety during these procedures.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a pediatric or adult male presenting with an undescended testis, a condition where one or both testes have not moved into the scrotal position. The patient is scheduled for surgical correction, such as orchiopexy, under general anesthesia. The procedure is performed in a hospital inpatient setting (Place of Service 21). The anesthesiology team evaluates the patient preoperatively, administers anesthesia, monitors intraoperative status, and provides post-anesthesia care. The workflow includes coordination between the surgical and anesthesia teams, documentation of anesthesia time, and use of appropriate modifiers based on the provider type and anesthesia care delivered.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia.QX: CRNA service with medical direction by a physician. Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia under the medical direction of a physician.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
367500000X | Certified Registered Nurse Anesthetist |
207LC0200X | Critical Care Medicine (Anesthesiology) |
- Specialties Represented:
- Anesthesiology
- Certified Registered Nurse Anesthetist
- Critical Care Medicine (Anesthesiology)
Related Diagnoses
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M84.459: Pathological fracture, pelvis- Indicates a fracture in the pelvic region due to underlying pathology, which may be relevant if pelvic abnormalities are present during undescended testis surgery.
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S32.9XXA: Fracture of pelvis, initial encounter- Represents an acute pelvic fracture, possibly relevant if trauma is involved in the clinical scenario.
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M87.051: Idiopathic aseptic necrosis of pelvis- Refers to bone necrosis in the pelvis without a known cause, which may complicate surgical procedures in the pelvic area.
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S32.810A: Multiple fractures of pelvis with stable disruption of pelvic ring, initial encounter- Indicates multiple pelvic fractures with stable disruption, relevant in cases where pelvic stability is a concern during surgery.
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M84.459A: Pathological fracture in neoplastic disease, pelvis, initial encounter- Represents a pathological pelvic fracture due to neoplastic disease, which may be associated with undescended testis if malignancy is present.
Related CPT Codes
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00926: Anesthesia, male genital removal of testis- Used for procedures involving removal of the testis, such as orchiectomy. This code is related to
00924as both involve anesthesia for male genital procedures, but00926is specific to removal.
- Used for procedures involving removal of the testis, such as orchiectomy. This code is related to
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00922: Anesthesia, sperm duct surgery- Used for anesthesia during procedures on the sperm duct, such as vasectomy or repair. This code is related to
00924as both are anesthesia services for male genital surgeries, but00922is specific to sperm duct operations.
- Used for anesthesia during procedures on the sperm duct, such as vasectomy or repair. This code is related to
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Clinical Workflow Relation:
- These codes may be used as alternatives depending on the specific surgical procedure performed. They are not typically billed together but represent anesthesia services for different male genital surgeries.
National Reimbursement Benchmarks
For CPT code 00924, the national mean rate for BUCA (average commercial) is $123.37, which is substantially higher than the UnitedHealth Group mean rate of $65.59. Blue Cross Blue Shield and Cigna both report the highest mean rates nationally, at $249.89 and $249.01 respectively, while Aetna's mean rate is $145.86.
Rate dispersion, measured as the difference between the 75th and 25th percentiles, varies significantly across payers. Blue Cross Blue Shield and Cigna exhibit the widest ranges ($168.00 and $258.00, respectively), indicating greater variability in contracted rates. UnitedHealth Group has the tightest range at $25.42, suggesting more consistent reimbursement levels across providers. Aetna and BUCA show moderate dispersion, with ranges of $218.33 and $134.39, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a wide spread in reimbursement rates for CPT code 00924, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($301.52 minus $225.80 = $75.72), while Aetna, Cigna, and UnitedHealth Group have much narrower spreads, all under $21.00. Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and Aetna are 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 significant differences in reimbursement levels across payers for this procedure.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00924 in Alaska, with a mean rate of $269.41.
- 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, especially Blue Cross Blue Shield, are notably higher than national benchmarks, except for UnitedHealth Group, which remains low.
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.