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See a sample rate comparisonCPT 00811 Fee Schedule
CPT 00811 is classified under Anesthesia, in the Anesthesia for Procedures on the Lower Abdomen subgroup.
Anesthesia For Lower Intestina, Anesthesia For Lower Intestinal Endoscopic Procedures Endoscope Introduced Distal To Duodenum Not Otherwise Specified Nterpretation And Report Tery Disease Data Preparation And Transmission A
| Key Fact | Detail |
|---|---|
| Service Type | Anesthesia Anesthesia for Procedures on the Lower Abdomen |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | QZ - CRNA service; without medical direction by a physician QS - Monitored anesthesia care service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 00811 |
National average anesthesia conversion factor for CPT 00811 by major payers:
$45.29
BCBS / Anthem
$69.45
UnitedHealthcare
$68.62
Aetna
$167.52
Cigna
Compare published rates across providers.
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CPT 00811
5 of 25 sample ratesHigher to lower in this preview
Michael Pesce
Mercy Health System Corporation
$385.51Published rateStephen Rivoli
$121.79Published rateSynergy Anesthesia Ct PLLC
$102.00Published rateSanjai Isaac
Allied Digestive Health, LLC
$90.00Published rateShurea Wilson
Methodist Associates In Healthcare Inc
$40.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 00811 vs. Other Anesthesia for Procedures on the Lower Abdomen Codes
The table lists codes related to 00811. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 00800-CPT | Low | Anesthe For Procs On Lower Anterio Abdomi Wall; Not Otherw, Anesthesia For Procedures On Lower Anterior Abdominal Wall; Not Otherw |
| 00802-CPT | Moderate | Anesthesia Abdomen Shaping, Anesthesia Services For Surgery To Remove Excess Skin And Reconstruct The Lower Portion Of The Abdominal Wall (Abdominal Apron). |
| 00811-CPT | Low | Anesthesia For Lower Intestina, Anesthesia For Lower Intestinal Endoscopic Procedures Endoscope Introduced Distal To Duodenum Not Otherwise Specified Nterpretation And Report Tery Disease Data Preparation And Transmission A |
| 00812-CPT | Low | Anesthesia For Lower Intestina, Anesthesia For Lower Intestinal Endoscopic Procedures Endoscope Introduced Distal To Duodenum Screening Colonoscopy Nterpretation And Report Tery Disease Data Preparation And Transmission A |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 00811. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 00811 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
To find out the estimated cost of a medical procedure, you can start by contacting your insurance provider directly, as they can provide estimates based on your specific plan's coverage. For a more direct and detailed way to look up specific fees based on CPT codes and your location, you can utilize tools like Payerprice. It offers a fee schedule lookup tool that can provide more granular cost information relevant to your situation.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit alphanumeric codes used by healthcare providers, payers, and government agencies to describe medical, surgical, and diagnostic services performed by physicians and other healthcare professionals. They are essential for accurate medical billing and for understanding the specific services rendered.
Medical costs can vary significantly due to several factors, including the healthcare provider's negotiated rates with different insurance companies, geographic location, the complexity of the procedure, the type of facility where the service is provided (e.g., hospital vs. outpatient clinic), and whether the provider is in-network or out-of-network for your specific insurance plan. Market competition and operational costs also play a role in these price differences.
These are common terms for out-of-pocket costs in health insurance plans: * **Co-pay:** A fixed amount you pay for a covered health service after you've paid your deductible (though some plans have co-pays that don't apply to the deductible). * **Deductible:** The amount you must pay out-of-pocket for medical services before your insurance company begins to pay its share. * **Coinsurance:** Your share of the cost of a healthcare service, calculated as a percentage (e.g., 20%) of the allowed amount for the service, which you typically pay after you've met your deductible. These three components contribute to your total healthcare expenses.
For specific fee schedules based on CPT codes and your location, you can use specialized tools designed for this purpose. Payerprice offers a fee schedule lookup tool that allows users to search with CPT codes and specific locations to get detailed pricing information. This can provide more precise data than general estimates or information from insurance providers alone.