CPT 00865 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 • Anesthesia for Procedures on the Lower Abdomen |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • P3 - A patient with severe systemic disease • QX - Qualified nonphysician anesthetist service: With medical direction by a physician |
| Complexity Level | Moderate |
National average anesthesia conversion factor for CPT 00865 by major payers:
$58.85
$55.82
$56.69
$54.74
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 00865 | ||||||
United | 00865 | $35.00 | 1528421740 - JENESSA JOB | 954457756 - (CA) CEDARS-SINAI MEDICAL CARE FOUNDATION | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $63.00 | 1134141286 - RONALD ROTHSTEIN | 330359522 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $84.66 | 1508290586 - JASON KANEL | 951965700 - (CA) ANESTHESIA SERVICE MEDICAL GROUP, INC. | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $78.00 | 1417192295 - GABRIEL GALLAGHER | 954656412 - (CA) PACIFIC VALLEY MEDICAL GROUP | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $128.69 | 1760735583 - ANN SHAH | 943281657 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $46.34 | 1700073178 - ERIKA HUBBARD | 824591168 - (CA) TRIAS GLOBAL LLC | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $48.00 | 1902885957 - JOHN MARCUM | 900581130 - (CA) CHILDRENS CRITICAL CARE OF VENTURA COUNTY INC | CA | Critical Care Medicine (Anesthesiology) Physician (207LC0200X) |
United | 00865 | $117.22 | 1144326117 - VINOD KOTHAPA | 952226406 - REGENTS OF THE UNIVERSITY OF CALIFORNIA AT IRVINE | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $86.00 | 1710921457 - ROBERT KOPEL | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $62.70 | 1528351582 - ARVINDER GILL | 954845900 - (CA) UNIVERSAL PAIN MANAGEMENT MEDICAL CORPORATION | CA | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 00865 | $99.00 | 1336402320 - LOUIS SADDIC | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $38.00 | 1336200435 - BEHNOUSH ZARRINI MD, INC. | 201394672 - (CA) BEHNOUSH ZARRINI MD INC | CA | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 00865 | $121.22 | 1902089824 - ELAINE LIEW | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $86.00 | 1073566428 - GREGORY JUAREZ | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $35.00 | 1457888687 - JULIANNE AHDOUT | 954457756 - (CA) CEDARS-SINAI MEDICAL CARE FOUNDATION | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 00865 vs. Other Anesthesia for Procedures on the Lower Abdomen Codes
The CPT 00865 code is part of the Anesthesia services used for Anesthesia for Procedures on the Lower Abdomen. 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 00865 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 |
|---|---|---|
| 00862-CPT | Moderate | Anesthesia For Extraperitoneal Procedures In Lower Abdomen, Including Urinary Tract; Renal Procedures, Including Upper One-Third Of Ureter, Or Donor Nephrectomy |
| 00864-CPT | Moderate | Anes Extraperitoneal Low Abd; Total Cyst |
| 00865-CPT | Moderate | Anesthesia For Extraperitoneal Procedures In Lower Abdomen, Including Urinary Tract; Radical Prostatectomy (Suprapubic, Retropubic) |
| 00866-CPT | Moderate | Anes Extraperitoneal Low Abd; Adrenalect |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 00865. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 00865 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 00865) and we'll show you how you compare in 15 minutes or less.