Summary & Overview
CPT 00938: Anesthesia for Vasectomy Procedures
Headline: Anesthesia Code CPT 00938 Clarifies Billing for Vasectomy Procedures
Lead: CPT 00938 designates anesthesiology services for vasectomy procedures on male genitalia and is relevant for clinicians, anesthesiology departments, and payers who manage ambulatory surgical care workflows. It separates the anesthesia encounter from the surgical procedure for coding and payment purposes.
What this code represents and why it matters: CPT 00938 identifies the anesthesia service provided during unilateral or bilateral vasectomy and supports accurate billing and clinical documentation. Nationally, clear use of this code helps ensure appropriate reimbursement, resource allocation in ambulatory surgical centers, and consistent clinical coding across facilities.
Key payers covered: This summary addresses coverage considerations relevant to Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
What readers will learn: The publication explains the clinical context of CPT 00938, its placement within anesthesiology service lines, common sites of service, and the relationship to the underlying surgical procedure. Readers will find benchmarks for typical use in ambulatory surgical settings, common billing modifiers and coding companions, and guidance on how this anesthesia code aligns with related urological and surgical procedure codes. The report also notes where input data is missing: Service line metadata not provided. Data not available in the input is identified where applicable.
CPT Code Overview
CPT 00938 describes anesthesia for procedures on male genitalia (including open urethral procedures); vasectomy, unilateral or bilateral (separate procedure). This code is used for anesthesiology services provided during vasectomy procedures and reflects the anesthesia component distinct from the surgical procedure itself. The typical site of service for CPT 00938 is an Ambulatory Surgical Center (POS 24) and the service type is Anesthesiology.
Clinical & Coding Specifications
Clinical Context
A typical adult male presents to an Ambulatory Surgical Center (POS 24) requesting sterilization or referred for surgical management of a male genital condition. The procedure performed is a vasectomy, unilateral or bilateral, typically coded as 55250, and anesthesia is provided under 00938 for procedures on male genitalia. The patient is evaluated preoperatively by the anesthesia team (Anesthesiology taxonomy 207L00000X) for fitness for monitored anesthesia care or local/regional anesthesia. The workflow includes pre-op assessment, placement of monitored anesthesia care or local anesthetic per the anesthesia plan, intraoperative monitoring, performance of the vasectomy by a urologist or urological surgeon (taxonomies 207V00000X and 208800000X), and postoperative recovery in the ASC before discharge to home. Common presenting indications include sterilization (Z30.2) or symptomatic disorders of the male genitalia such as phimosis (N47.1), paraphimosis (N47.2), balanitis (N48.1), or unspecified male genital disorders (N50.9) when the surgeon deems vasectomy appropriate or when concurrent genital procedures are performed.
Coding Specifications
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Modifiers
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QS: Monitored anesthesia care service. Used when the anesthesia service provided is monitored anesthesia care rather than general anesthesia or regional anesthesia. -
P1: A normal healthy patient. Used to indicate the American Society of Anesthesiologists (ASA) physical status classification of a healthy patient. -
Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|
207L00000X | Anesthesiology |
207V00000X | Urology |
208800000X | Urological Surgery |
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Notes
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Use the anesthesia taxonomy (
207L00000X) to identify the billing provider who furnishes00938. -
Use the urology and urological surgery taxonomies (
207V00000X,208800000X) to identify the operating surgeon who performs55250or related procedures. -
If a field from the input is missing, state: Data not available in the input.
Related Diagnoses
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Z30.2: Encounter for sterilization- Clinical relevance: Indicates the encounter is for sterilization, the most common indication for a vasectomy and for reporting when sterilization counseling or procedure is the purpose of the visit.
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N50.9: Disorder of male genital organs, unspecified- Clinical relevance: Used when a more specific male genital diagnosis is not documented but surgical management such as vasectomy or related procedures is performed.
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N47.1: Phimosis- Clinical relevance: Phimosis is a disorder of the foreskin that may co-occur with other male genital conditions; it can be part of the surgical context when genital procedures are performed.
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N47.2: Paraphimosis- Clinical relevance: Paraphimosis is an acute condition of the foreskin that may necessitate urgent genital procedures and affect anesthesia planning.
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N48.1: Balanitis- Clinical relevance: Inflammation of the glans that may coexist with other genital pathologies and be relevant to the operative plan or indication for surgery.
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If a list is empty or missing, state: Data not available in the input.
Related CPT Codes
| CPT Code | Description | Relationship to 00938 |
|---|---|---|
55250 | Vasectomy, unilateral or bilateral (separate procedure) | Primary surgical procedure for which 00938 anesthesia code is commonly reported; anesthesia for vasectomy. |
00910 | Anesthesia for procedures on male genitalia | Related anesthesia code for other types of male genital procedures; alternative anesthesia descriptors within the same family. |
00920 | Anesthesia for procedures on male genitalia; vasotomy, vasoligation, or vasorrhaphy | Specific anesthesia code for vasotomy/vasoligation/vasorrhaphy procedures; clinically related and may be used for similar vas deferens procedures. |
00930 | Anesthesia for procedures on male genitalia; orchiectomy | Anesthesia code for orchiectomy; related by anatomic site and anesthesia specialty but used for a different surgical procedure. |
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Common usage:
55250is the surgical code typically paired with00938for vasectomy cases. The other0091x–0093xanesthesia codes represent related anesthesia services for alternate male genital procedures and may be used as alternatives depending on the exact procedure performed. -
If a list is empty or missing, state: Data not available in the input.
National Reimbursement Benchmarks
National commercial mean rates sit well above Medicare for CPT 00938; BUCA (the average commercial benchmark) has a mean of $129.81 compared with Medicare, which is not provided in the input (reported here as unavailable). Blue Cross Blue Shield, Cigna, and Aetna report higher mean allowed rates than BUCA, while UnitedHealth Group reports a substantially lower mean.
Rate dispersion (P75 minus P25) varies notably across payers. Cigna shows one of the widest spreads (P75 $348.00 minus P25 $90.00 = $258.00), indicating broader variability, while UnitedHealth Group is among the tightest with a spread of $25.33 (P75 $75.67 minus P25 $50.33). Aetna and BUCA show moderate dispersion, and Blue Cross Blue Shield displays a relatively narrow commercial spread compared with Cigna. The table and chart below present the full breakdown.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a significant rate spread for CPT code 00938, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $75.87. This spread is much larger than that seen with Aetna, Cigna, and UnitedHealth Group, which all have minimal spreads of $4.00 or less. The presence of such a wide range indicates substantial variability in reimbursement rates among payers in Alaska.
Compared to national averages, Alaska's mean rates for most payers are notably higher, especially for Blue Cross Blue Shield and BUCA. Cigna, however, has a lower mean rate in Alaska than nationally. The table and chart below present the full breakdown of payer-specific reimbursement benchmarks for Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00938 in Alaska, with a mean rate of $269.36.
- UnitedHealth Group offers the lowest mean rate in Alaska at $75.12.
- Alaska's mean rates for most payers are higher than their respective national averages, except for Cigna, which is notably lower in Alaska.
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.