Summary & Overview
CPT 00942: Anesthesia for Vaginal and Associated Procedures
CPT code 00942 covers anesthesia services for surgical procedures involving the female vagina and related structures, such as biopsies, incisions, repairs, excisions, and open urethral operations. This code is nationally significant for anesthesiology practices, ambulatory surgical centers, and hospitals, as it ensures proper billing and reimbursement for anesthesia care during gynecological surgeries. The publication examines coverage and policy considerations from major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Readers will gain insight into payer coverage trends, clinical benchmarks, and policy updates relevant to anesthesia services for vaginal procedures. The analysis provides context on typical sites of service, common clinical scenarios, and the importance of accurate coding for compliance and reimbursement. Key modifiers, associated taxonomies, and related codes are also discussed to support understanding of the broader billing landscape. This summary serves as a resource for healthcare professionals, administrators, and policy analysts seeking clarity on CPT 00942 and its role in anesthesia billing for gynecological procedures.
CPT Code Overview
CPT 00942 is designated for anesthesia services provided during procedures on the female vagina and associated structures. These procedures may include biopsy, incision into the vagina, repair of vaginal tears, excision of the vagina, and open urethral procedures. The service type is anesthesia, and it is most commonly performed in an Ambulatory Surgical Center (Place of Service 24). This code is essential for accurately reporting and reimbursing anesthesia care during gynecological surgeries.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a female patient presenting to an ambulatory surgical center for a procedure on the vagina or associated structures. This may include a vaginal biopsy, incision into the vagina, repair of a vaginal tear, excision of vaginal tissue, or an open urethral procedure. The patient is assessed preoperatively by an anesthesiologist, who determines the appropriate anesthesia plan. The procedure is performed under anesthesia, with the anesthesiologist monitoring the patient throughout. The workflow includes preoperative evaluation, administration of anesthesia, intraoperative monitoring, and postoperative recovery. The service is typically provided in an ambulatory surgical center (Place of Service 24).
Coding Specifications
-
Modifier
QS: Indicates that monitored anesthesia care (MAC) was provided during the procedure. Used when the anesthesiologist is present and monitoring the patient, but not necessarily providing general anesthesia. -
Modifier
P1: Denotes that the patient is a normal, healthy individual with no systemic disease. Used to indicate the physical status of the patient for anesthesia risk assessment.
| Provider Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine (Anesthesiology) |
207LP2900X | Pediatric Anesthesiology |
These taxonomies represent providers specializing in anesthesia, pain management, and pediatric anesthesia.
Related Diagnoses
-
N50.0- Atrophy of testis: Although this diagnosis refers to a male genital condition, it may be included in the context of procedures involving sterilization or other genital surgeries where anesthesia is required. -
N50.1- Vascular disorders of male genital organs: Relevant for cases where vascular issues necessitate surgical intervention and anesthesia. -
N50.8- Other specified disorders of male genital organs: Used for male genital disorders not otherwise classified, potentially requiring anesthesia for surgical correction. -
N50.9- Disorder of male genital organs, unspecified: Applied when the specific disorder is not identified but anesthesia is needed for a related procedure. -
Z30.2- Encounter for sterilization: Indicates a patient encounter for sterilization procedures, which may involve anesthesia services for surgical intervention.
These diagnoses are clinically relevant as they represent conditions that may require surgical procedures necessitating anesthesia, even though the CPT code 00942 is specific to female anatomy. The inclusion of male genital diagnoses may reflect coding practices for certain sterilization or genital procedures.
Related CPT Codes
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00940: Under anesthesia for procedures on the perineum. This code is used when anesthesia is provided for surgical procedures specifically targeting the perineal region. It may be used as an alternative to00942if the procedure is limited to the perineum rather than the vagina or associated structures. -
00944: Under anesthesia for procedures on the perineum. Similar to00940, this code applies to anesthesia services for perineal procedures. It may be used in cases where the surgical intervention is focused on the perineum and not the vagina.
Both 00940 and 00944 are related to 00942 in that they cover anesthesia for procedures in adjacent anatomical regions. These codes are commonly used as alternatives depending on the exact location and nature of the surgical procedure.
National Reimbursement Benchmarks
For CPT code 00942, the national mean rate for BUCA (average commercial) is $141.89, which is substantially higher than typical Medicare rates, though Medicare data is not available in the input for this code. Among individual commercial payers, Cigna and Blue Cross Blue Shield have the highest mean rates at $248.92 and $247.58, respectively, while UnitedHealth Group is notably lower at $65.55.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Blue Cross Blue Shield and Cigna exhibit the widest ranges ($151.25 and $258.00, respectively), indicating greater variability in contracted rates. UnitedHealth Group has the tightest range at $25.50, suggesting more consistent reimbursement levels. The table and chart below present the full breakdown of national benchmarks for this code.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a wide spread in reimbursement rates for CPT code 00942 across commercial payers. Blue Cross Blue Shield has the largest rate spread, with a 75th percentile of $300.00 and a 25th percentile of $225.80, resulting in a $74.20 difference. Aetna, Cigna, and UnitedHealth Group all have minimal rate spreads, with their 25th, 50th, and 75th percentiles clustered closely together, indicating limited variability in negotiated rates. The table and chart below present the full breakdown by payer.
Compared to national averages, Blue Cross Blue Shield and BUCA payers in Alaska offer higher mean rates, while Cigna and UnitedHealth Group reimburse at levels below their national benchmarks. This highlights significant regional variation, with Alaska's commercial market showing both premium and discounted rates relative to national norms.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00942 in Alaska, with a mean rate of $269.15.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below the state average.
- Cigna and UnitedHealth Group both pay notably less in Alaska compared to their national averages, while Blue Cross Blue Shield pays above its 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.