Summary & Overview
CPT 01990: Anesthesia for Physiological Support During Organ Procurement
CPT code 01990 covers the provision of physiological support by an anesthesiology provider to a brain dead patient during organ procurement. This procedure is a critical component in the organ donation process, ensuring that organs remain viable for transplantation. The code is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its importance in hospital-based anesthesia services.
This publication provides a comprehensive overview of CPT code 01990, including its clinical context, typical site of service, and payer coverage. Readers will gain insight into the role of anesthesia in organ procurement, relevant policy updates, and benchmarks for billing and reimbursement. The analysis also highlights associated modifiers, taxonomies, and related codes, offering a clear understanding of how this service fits within broader anesthesiology and transplant care. The information is designed to support healthcare professionals, administrators, and policy analysts in navigating the complexities of medical billing and compliance for organ procurement anesthesia services.
CPT Code Overview
CPT code 01990 is used when an anesthesiology provider delivers physiological support to a brain dead patient during organ procurement. This service falls under the anesthesia category and is typically performed in an inpatient hospital setting (Place of Service 21). The code is essential in facilitating organ donation procedures, ensuring that the patient's physiological functions are maintained throughout the procurement process.
Clinical & Coding Specifications
Clinical Context
A typical scenario for CPT code 01990 involves a brain dead patient in an inpatient hospital setting (POS 21) who is maintained on physiological support by an anesthesiology provider during organ procurement. The clinical workflow includes the anesthesiology team monitoring and supporting vital functions, ensuring organ viability for transplantation. The patient is often dependent on enabling machines and devices, and the procedure is coordinated with surgical and transplant teams. Documentation focuses on the anesthesiology provider's role in maintaining physiological stability throughout the organ procurement process.
Coding Specifications
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Modifiers:
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QS: Monitored anesthesia care service. Used when the anesthesiology provider delivers monitored anesthesia care during the procedure. -
QX: CRNA service with medical direction by a physician. Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia care under physician supervision.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology 207LA0401XAnesthesiology Assistant 367500000XCertified Registered Nurse Anesthetist (CRNA)
These taxonomies represent providers qualified to deliver anesthesia services for organ procurement in brain dead patients.
Related Diagnoses
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Z00.6: Encounter for examination for normal comparison and control in clinical research program- Relevant when organ procurement is part of a clinical research protocol.
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Z99.89: Dependence on other enabling machines and devices- Indicates the patient's reliance on machines (e.g., ventilators) during organ procurement.
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R99: Ill-defined and unknown cause of mortality- Used when the cause of death is not clearly defined, applicable in brain death scenarios.
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G93.82: Brain death- Directly relevant as the procedure is performed on a brain dead patient.
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Z94.0: Kidney transplant status- Indicates prior kidney transplantation, relevant if the patient is a donor with transplant history.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
01991 | Anesthesia for diagnostic or therapeutic nerve blocks and injections | Alternative anesthesia services for nerve block procedures |
01992 | Anesthesia for diagnostic or therapeutic nerve blocks and injections | Alternative anesthesia services for nerve block procedures |
99100 | Anesthesia for patient of extreme age, younger than 1 year and older than 70 | May be used in conjunction for patients of extreme age undergoing organ procurement |
99116 | Anesthesia complicated by utilization of total body hypothermia | May be used together if hypothermia is induced during organ procurement |
Codes 01991 and 01992 are alternatives for nerve block procedures, while 99100 and 99116 may be used in addition to 01990 depending on patient age or procedural complexity.
National Reimbursement Benchmarks
National mean rates for CPT code 01990 show that commercial payers (BUCA) average $171.64, while Medicare rates are not available in the input. Among individual commercial payers, Cigna and Blue Cross Blue Shield have the highest mean rates at $403.27 and $379.44, respectively, while UnitedHealth Group is notably lower at $65.61.
Rate dispersion varies significantly across payers. Cigna exhibits the widest spread, with a difference of $518.67 between its 75th and 25th percentiles, indicating substantial variability in reimbursement. UnitedHealth Group has the tightest range, with only $25.29 separating its 75th and 25th percentiles, suggesting more consistent rates. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 01990, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($246.20), indicating substantial variability in payments. In contrast, Aetna, Cigna, and UnitedHealth Group have minimal rate spreads, with all percentiles clustered closely together, suggesting consistent but lower reimbursement levels. The BUCA composite also reflects a notable spread ($273.42), highlighting significant payer variation in Alaska.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably 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 and percentiles for Alaska, offering a clear view of the regional reimbursement landscape for CPT code 01990.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01990 in Alaska, with a mean rate of $481.62.
- UnitedHealth Group offers the lowest mean rate at $74.78.
- Alaska's mean rates for most payers, especially BCBS and BUCA, are significantly higher than national averages, while Cigna and UnitedHealth Group are below national means.
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