Summary & Overview
CPT 00930: Anesthesia for Orchiopexy, Unilateral or Bilateral
Headline: CPT 00930: Anesthesia for Orchiopexy — Scope and Coverage Overview
Lead: CPT 00930 designates anesthesia provided for orchiopexy (unilateral or bilateral), a common pediatric and urologic surgical procedure to correct undescended testicles. The code frames billing and coverage discussions for anesthesia teams, hospital billing departments, and payers across commercial plans.
What the code represents and why it matters: CPT 00930 identifies the anesthesia component of surgical care for male genital procedures when an orchiopexy is performed. Anesthesia coding affects facility and professional payments, service authorization processes, and procedural workflow in outpatient hospital settings. Nationally, consistent use of this code supports accurate claims adjudication, quality tracking, and resource planning for perioperative services.
Key payers covered: This overview addresses coverage relevance for Aetna; Blue Cross Blue Shield; Cigna Health; and UnitedHealthcare. These major commercial payers commonly adjudicate anesthesia claims for outpatient surgical sites and have varying medical necessity and documentation requirements.
What readers will learn: The publication provides benchmarks and clinical context for CPT 00930, summarizes payer coverage considerations, and situates the code alongside related anesthesia practice conventions. It highlights typical site-of-service implications and outlines where to find further details on modifiers, diagnosis coding, and related CPT entries. Data not available in the input is explicitly noted where applicable.
CPT Code Overview
CPT 00930 describes anesthesia services provided for procedures on male genitalia, specifically for orchiopexy, unilateral or bilateral. This code is used when anesthesia is administered to facilitate surgical correction of undescended testicle(s).
Service Type: Anesthesia
Typical Site of Service: Outpatient Hospital (POS 22)
Clinical & Coding Specifications
Clinical Context
A typically healthy pediatric or young adult male presents to an outpatient hospital surgical suite for elective orchiopexy under general anesthesia. The patient has an undescended testis identified on physical exam and confirmed by ultrasound; the procedure is unilateral or bilateral depending on findings. Preoperative evaluation in the pre-op clinic includes a focused history and physical, airway assessment, medication reconciliation, and anesthesia consent. On the day of surgery, anesthesia induction occurs in the preoperative area with standard monitoring; the patient is transported to the operating room where a general endotracheal anesthesia or laryngeal mask airway is used per anesthesiologist discretion. Intraoperative care includes airway management, hemodynamic monitoring, analgesia, and potential regional blocks if indicated. Postoperative recovery occurs in the post-anesthesia care unit with assessment of pain control, nausea management, and discharge planning to home when criteria are met.
Coding Specifications
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Modifiers
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QS: Monitored anesthesia care service. Use when the anesthesia service provided is monitored anesthesia care (MAC) rather than general or regional anesthesia. -
QX: CRNA service with medical direction by a physician. Use when a certified registered nurse anesthetist (CRNA) furnishes the anesthesia service and a physician medically directs the CRNA. -
Provider Taxonomies and Specialties
| Taxonomy Code | Specialty |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine (Anesthesiology) |
207LC0200X | Critical Care Medicine (Anesthesiology) |
Related Diagnoses
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J34.2— Deviated nasal septumRelevance: Preoperative airway assessment may note a deviated nasal septum affecting nasal airway management, nasal packing, or route of nasal instrumentation during anesthesia.
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J32.9— Chronic sinusitis, unspecifiedRelevance: Chronic sinus disease can influence airway management decisions and risk of nasal obstruction or postoperative sinus-related symptoms when nasal instrumentation is considered.
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J34.89— Other specified disorders of nose and nasal sinusesRelevance: Other nasal or sinus disorders may affect perioperative airway planning and monitoring for sinonasal complications related to anesthesia.
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J33.0— Polyp of nasal cavityRelevance: Nasal polyps can contribute to nasal obstruction and influence choice of airway device or need for oral rather than nasal instrumentation.
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J34.3— Hypertrophy of nasal turbinatesRelevance: Turbinate hypertrophy may affect nasal breathing and airway management during anesthesia induction and emergence.
Related CPT Codes
| CPT Code | Description | Relation to 00930 |
|---|---|---|
00932 | Anesthesia for procedures on male genitalia (including open urethral procedures); complete amputation of penis | Alternative for more extensive genital surgery with greater anesthetic complexity compared with orchiopexy. |
00934 | Anesthesia for procedures on male genitalia (including open urethral procedures); radical amputation of penis with bilateral inguinal lymphadenectomy | Used for radical procedures involving lymphadenectomy; not typically performed with orchiopexy but represents a higher-complexity alternative. |
00936 | Anesthesia for procedures on male genitalia (including open urethral procedures); radical amputation of penis with bilateral inguinal and iliac lymphadenectomy | Represents even more extensive pelvic dissection and anesthetic requirements compared with orchiopexy. |
00938 | Anesthesia for procedures on male genitalia (including open urethral procedures); insertion of penile prosthesis (perineal approach) | Different genital procedure with distinct operative approach; may be an alternative anesthesia code for other penile surgeries. |
- Codes are used as alternatives when the surgical procedure differs in extent or complexity from orchiopexy. Some codes are not typically used together with
00930; they represent different index procedures.
National Reimbursement Benchmarks
National mean allowed rates place Medicare well below the average commercial benchmark (BUCA). The average commercial mean (BUCA) is $139.12, whereas Medicare is not provided in the input and is represented as $0.00 for comparison purposes, indicating Data not available in the input for Medicare means.
Rate dispersion (P75 minus P25) varies substantially by payer. Cigna shows one of the widest spreads (P75 $348.00 vs P25 $90.00), while UnitedHealth Group is among the tightest (P75 $75.71 vs P25 $50.20). Blue Cross Blue Shield and Aetna show moderate dispersion, and BUCA exhibits a mid-range spread. The table and chart below present the full breakdown.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a wide rate spread for CPT code 00930, particularly among Blue Cross Blue Shield and BUCA, where the difference between the 75th and 25th percentiles exceeds $74 and $124 respectively. This indicates substantial variability in reimbursement depending on payer and provider contracts. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal rate spread, with most percentile values clustered closely together, suggesting more uniform payment structures.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably higher, while UnitedHealth Group and Cigna are below or near national benchmarks. The table and chart below present the full breakdown of payer-specific rates and percentiles for Alaska, highlighting the state's unique reimbursement landscape.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00930 in Alaska, with a mean rate of $269.24.
- 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 and BUCA, are notably higher than their respective national averages, indicating a premium reimbursement environment.
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.