CPT 00860 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Anesthesia for Procedures on the Lower Abdomen Anesthesia |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None AA - Anesthesia by anesthesiologist QX - Qualified nonphysician anesthetist service: With medical direction by a physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 00860 |
National average anesthesia conversion factor for CPT 00860 by major payers:
$57.80
$55.83
$56.47
$54.55
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 00860 | $99.00 | 1891290813 - LAUREN SARTOR | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $67.00 | 1093158263 - TSUNG TSOU | 454127530 | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $83.00 | 1336358829 - RUBEN KOSHY | 471884235 - CEP AMERICA | CA | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 00860 | $121.22 | 1285674986 - RICHARD RUFFALO | 954395492 | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $55.50 | 1710067863 - ANNA L HARRIS | 952226406 - REGENTS OF THE UNIVERSITY OF CALIFORNIA AT IRVINE | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $75.00 | 1487695730 - BARRY ROSE | 943158784 - (CA) ANESTHESIA CARE ASSOCIATES MEDICAL GROUP, INC. | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $91.75 | 1972536704 - LOWELL REYNOLDS | 330672915 - FACULTY PHYSICIANS AND SURGEONS OF LLUSM | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $56.00 | 1932660693 - CINDY YOUN | 882872979 - (CA) VALLEY REGIONAL ANESTHESIA ASSOCIATES INC | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $60.00 | 1316474968 - MICHAEL PEREZ | 680334324 | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $70.00 | 1447604103 - XIAO LIU | 760221050 | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $75.00 | 1336608249 - SHANE MCGUIRE | 203395567 | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $62.00 | 1104026012 - JERRAD ROBY | 680238424 - (CA) ANESTHESIA & ANALGESIA MEDICAL GROUP, INC. | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $50.00 | 1841333960 - RONGHUAN LIU | 273068347 | CA | Anesthesiology Physician (207L00000X) |
United | 00860 | $40.00 | 1245499045 - JONELON TSANG | 270420867 - (CA) JUSTIN LO MD A PROFESSIONAL ME | CA | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 00860 | $67.00 | 1437324514 - ARPNA DAVE' | 882517801 - (CA) MOCHI MEDICAL PA | CA | Anesthesiology Physician (207L00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 00860 vs. Other Anesthesia Codes
The CPT 00860 code is part of the Anesthesia for Procedures on the Lower Abdomen services used for Anesthesia. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 00860 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 00813-CPT | Moderate | Anesthesia For Combined Upper, Anesthesia For Combined Upper And Lower Gastrointestinal Endoscopic Procedures Endoscope Introducedboth Proximal To And Distal To The Duodenum Nterpretation And Report Tery Disease Data Preparation And Transmission A |
| 00860-CPT | Moderate | Anesthesia Abdominal Surgery, Anesthesia Services For A Procedure Involving A Structure Accessible Through The Lower Abdomen Such As The Bladder Urinary Tract And Adrenal Glands. |
| 00862-CPT | Moderate | Anesthesia For Kidney Surgery, Anesthesia Services Provided For All Types Of Surgery On The Kidneys Including Procedures Involving The Upper Part Of The Urinary Tract Between The Bladder And The Kidneys. |
| 00864-CPT | Moderate | Anesthesia Bladder Surgery, Anesthesia Services For A Surgery On The Bladder. Examples Of These Procedures Include Removal Of A Tumor Bladder Stones Or The Bladder Itself. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 00860. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 00860 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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