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 for Procedures on the Lower Abdomen Anesthesia |
| 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 |
| Medicare Fee Schedule | View Medicare rates for 00865 |
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 |
|---|---|---|---|---|---|---|
United | 00865 | $128.69 | 1457812281 - MIKHAELA ARAMBULO | 943281660 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $86.00 | 1265466114 - MOR-DAK CHAN | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $128.69 | 1760735583 - ANN SHAH | 943281657 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $53.00 | 1710971502 - KELVIN MARK | 464150987 - (CA) VALLEY CHILDRENS MEDICAL GROUP | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $121.22 | 1902089824 - ELAINE LIEW | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $81.44 | 1750308466 - IHAB DOROTTA | 330672915 - FACULTY PHYSICIANS AND SURGEONS OF LLUSM | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $86.00 | 1922023233 - JOHNATHAN PREGLER | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $99.00 | 1952545535 - JASON HIRSCH | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $38.00 | 1144238429 - JOHN BRAZILL | 208703660 - (CA) BAKERSFIELD PAIN MANAGEMENT, INC. | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $128.69 | 1821592809 - ELISE DELAGNES | 943281663 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $86.00 | 1184666802 - MAGGY RIAD | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $35.00 | 1528421740 - JENESSA JOB | 954457756 - (CA) CEDARS-SINAI MEDICAL CARE FOUNDATION | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $54.00 | 1487605630 - MICHAEL OSTROVSKY | 454116690 - (CA) PENINSULA ANESTHESIA CONSULTANTS, INC. | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $113.00 | 1619921103 - RAMAKRISHNA THONDAPU | 680273974 - SUTTER VALLEY MEDICAL FOUNDATION | CA | Anesthesiology Physician (207L00000X) |
United | 00865 | $99.00 | 1861436800 - PHILIP LEVIN | 954377219 | 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 00865 vs. Other Anesthesia Codes
The CPT 00865 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 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 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. |
| 00865-CPT | Moderate | Anes Xtrprt Lwr Abd Prst8ect, Anesthesia For Extraperitoneal Procedures In Lower Abdomen Including Urinary Tract; Radical Prostatectomy (Suprapubic Retropubic) |
| 00866-CPT | Moderate | Anes Xtrprt Lw Abd Adrnlctmy, Anesthesia For Extraperitoneal Procedures In Lower Abdomen Including Urinary Tract; Adrenalectomy |
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.
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