{"id":170811,"date":"2026-07-31T13:11:01","date_gmt":"2026-07-31T13:11:01","guid":{"rendered":"https:\/\/pabau.com\/?p=170811"},"modified":"2026-08-17T11:41:15","modified_gmt":"2026-08-17T11:41:15","slug":"cpt-code-00926","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/","title":{"rendered":"CPT code 00926: Anesthesia for male genitalia procedures"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 00926: Anesthesia for male genitalia procedures\",\"description\":\"CPT code 00926 covers anesthesia for male genitalia procedures including radical orchiectomy (inguinal) and open urethral procedures. 4 base units, modifiers, reimbursement rates, and billing guidelines.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00926\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-30\",\"dateModified\":\"2026-07-31\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 00926 covers anesthesia for male genitalia procedures, specifically radical orchiectomy (inguinal) and open urethral procedures.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The code carries 4 anesthesia base units, and payment follows the formula (base units + time units) x conversion factor.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Because 00920 carries 3 base units, choosing it instead of 00926 understates the claim by one unit, or about $20 at 2026 Medicare rates.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Missing modifiers, mismatched ICD-10 codes, and imprecise start and stop times cause most 00926 denials and underpayments.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau helps anesthesia teams document physical status, validate modifiers, and submit cleaner 00926 claims.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 00926 covers anesthesia for procedures on the male genitalia, specifically radical orchiectomy through an inguinal approach and open urethral procedures. It carries 4 anesthesia base units. Payment is the sum of base units and time units, multiplied by the payer&rsquo;s conversion factor.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This guide covers the official descriptor, the 2026 Medicare rates, and the modifiers every 00926 claim needs. It also covers physical status modifiers P1-P6, ICD-10 pairings, and the denial patterns that come up most often.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\">\n<div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div>\n<\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">CPT code 00926: definition and procedure description<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 00926 describes anesthesia services for procedures performed on the male genitalia. Two distinct procedure categories fall under this code: radical orchiectomy via the inguinal approach, and open urethral procedures. Both share the same 4 base unit value, so code selection does not vary by which procedure the surgeon performs.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Text<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Long description<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on male genitalia; including open urethral procedures; radical orchiectomy, inguinal<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Short description<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesth male genitalia proc<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT section<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on the male genitalia (00920-00938)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia (section 00100-01999)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Radical orchiectomy via the inguinal approach is the primary procedure associated with 00926. It is used most often for testicular malignancy, where complete removal of the testis and spermatic cord through an inguinal incision is the surgical standard. Open urethral procedures in this code range typically involve urethral reconstruction or stricture repair requiring general or regional anesthesia.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association (AMA)<\/a> maintains the CPT code set, including the 00920 series. Code descriptions are updated annually; always verify against the current year&rsquo;s AMA CPT manual before using 00926 on a claim.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Anesthesia base units and reimbursement formula<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 00926 carries 4 anesthesia base units. That value comes from the American Society of Anesthesiologists (ASA) Relative Value Guide. CMS publishes the same number in its anesthesia base unit file, and most payer and state fee schedules follow it. Base units represent the inherent complexity and risk of the anesthesia service, independent of how long the procedure takes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Check that number against a base unit schedule rather than a secondary listing. The 7-unit value sometimes attached to 00926 belongs to CPT 00904, anesthesia for a radical perineal procedure. That code sits in the perineum range, not the male genitalia range.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Anesthesia reimbursement is calculated differently from standard E\/M or surgical codes. Payers do not pay a flat fee. They apply a unit-based formula, and the same formula drives every code in the anesthesia section.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Formula component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">00926 value<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Base units (B)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fixed ASA-assigned value reflecting procedure complexity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">4<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Time units (T)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1 unit per 15 minutes of anesthesia time (standard; some payers differ)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Variable by case<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Qualifying circumstance (QCF)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Additional units for qualifying circumstances (for example, extreme age or controlled hypotension)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">0-5, case-specific<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Conversion factor (CF)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Dollar amount per unit set by payer; varies by locality and contract<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Payer-specific<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Formula:<\/strong> (base units + time units + QCF) x conversion factor = reimbursement<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Worked example:<\/strong> A 60-minute radical orchiectomy (inguinal) generates 4 time units (60 min \/ 15). Add the 4 base units and apply the 2026 national Medicare conversion factor of $20.4976. That gives (4 + 4) x $20.4976 = $163.98 before geographic adjustment. Physical status modifiers can add further units for higher-acuity patients, where the payer recognizes them.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The 15-minute time unit interval is the Medicare standard and the most widely used convention in commercial contracting. Verify the interval in each payer contract, as some use 10-minute intervals, which meaningfully changes the total unit count on longer procedures.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Track anesthesia start and stop times in your operative record to the minute. Even a 1-minute rounding error that crosses the 15-minute threshold changes your time unit count and can trigger a payment discrepancy or audit.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Time unit calculation and reporting<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Anesthesia time begins when you start preparing the patient for anesthesia and ends when the patient can be safely handed to postoperative care. Each 15 minutes inside that window is one time unit under Medicare rules.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Time carries most of the payment on a 00926 claim. A 90-minute case generates 6 time units against the code&rsquo;s 4 base units, so time accounts for well over half the total.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Anesthesia time<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Time units<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Total units (4 base + time)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 Medicare payment<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">30 minutes<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">2<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">6<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">$122.99<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">45 minutes<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">3<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">7<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">$143.48<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">60 minutes<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">4<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">8<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">$163.98<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">90 minutes<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">6<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">10<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">$204.98<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">120 minutes<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">8<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">12<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">$245.97<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Figures use the 2026 national anesthesia conversion factor of $20.4976 and no geographic adjustment. Your locality rate will differ.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare wants the exact number of anesthesia minutes on the claim, and the contractor converts them into units, fractions included. Some commercial payers instead round to a whole unit, and a few use a 10-minute interval. Both conventions change the total, so read the contract before you model expected payment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Discontinuous time is reported as the sum of the periods you were actively present with the patient. Do not bill the interval between two blocks of anesthesia care as continuous time.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Medicare reimbursement rates for 00926 in 2026<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare anesthesia reimbursement uses the unit-based formula above. The Centers for Medicare and Medicaid Services (CMS) sets the conversion factor each year in its <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">Physician Fee Schedule<\/a>. For 2026 the national anesthesia conversion factor is $20.4976 per unit, or $20.5998 for qualifying APM participants. The 2025 figure was $20.3178, so the year-over-year movement is under 1%.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Geographic Practice Cost Indices (GPCI) adjust this base rate by locality. A practice in Manhattan will receive a higher effective rate than one in a rural Midwestern state for the same CPT 00926 claim. Medicare Administrative Contractors (MACs) process claims by region and may publish locality-specific anesthesia conversion factors.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Reimbursement variable<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Base units<\/td>\n<td style=\"padding:12px 16px;color:#374151\">4 (the ASA Relative Value Guide and the CMS anesthesia base unit file agree)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2026 Medicare CF (national)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$20.4976\/unit, or $20.5998 for qualifying APM participants, before GPCI adjustment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2025 Medicare CF (national)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$20.3178\/unit<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Sample payment (60-min case, P1)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">(4 + 4) x $20.4976 = ~$163.98 before GPCI<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Commercial payer rates<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Negotiated per contract; typically higher than Medicare<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Rate lookup tool<\/td>\n<td style=\"padding:12px 16px;color:#374151\"><a href=\"https:\/\/fastrvu.com\/tools\/rvu-lookup\" target=\"_blank\" rel=\"nofollow noopener\">FastRVU rate lookup<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial payer contracts are negotiated separately and typically pay above Medicare rates. If your practice bills multiple payers, track contracted conversion factors by payer to project expected reimbursement per 00926 claim accurately. Good medical billing software lets you map payer-specific rates to individual codes, so nothing goes out at the wrong conversion factor.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Modifiers on a 00926 claim<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Anesthesia modifier selection on a 00926 claim signals two things to the payer. It says who administered the anesthesia, and what condition the patient was in. Getting either wrong is a fast path to denial or a compliance audit.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Meaning<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">AA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia services performed personally by anesthesiologist<\/td>\n<td style=\"padding:12px 16px;color:#374151\">MD anesthesiologist personally performs entire service without CRNA involvement<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">QK<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medical direction of 2-4 concurrent anesthesia procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesiologist medically directs CRNAs on multiple concurrent cases<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">QX<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CRNA service under medical direction of a physician<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CRNA performs service under physician medical direction, and pairs with QK on the physician claim<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">QY<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medical direction of one CRNA by an anesthesiologist<\/td>\n<td style=\"padding:12px 16px;color:#374151\">One-to-one medical direction scenario<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">QZ<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CRNA service without medical direction of a physician<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Independent CRNA billing where state law and payer policy allow<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h3 class=\"wp-block-heading\">Physical status modifiers (P1-P6)<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Physical status modifiers reflect patient health at the time of anesthesia. They are required on every anesthesia claim and influence payment when payers recognize additional units for higher-acuity classifications.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Patient description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Additional base units (where recognized)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">P1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Normal healthy patient<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">0<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">P2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Patient with mild systemic disease<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">0<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">P3<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Patient with severe systemic disease<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">1<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">P4<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Patient with severe systemic disease that is a constant threat to life<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">2<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">P5<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Moribund patient not expected to survive without the operation<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">3<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">P6<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Brain-dead patient declared for organ donation<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">N\/A<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare does not recognize physical status unit additions for P3-P5. Many commercial payers do recognize them. Confirm each payer&rsquo;s policy before including those additional units in your claim calculation. Underbilling because you assumed a payer follows Medicare&rsquo;s physical status rules costs revenue. Overbilling triggers compliance risk.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CRNA independent billing under modifier QZ is permitted only where state supervision law allows opt-out and the payer accepts independent CRNA billing. This varies by state and by payer policy, so confirm before submitting. Maintaining solid HIPAA-compliant documentation workflows that capture provider credentials alongside the anesthesia record protects you when payer audits request proof of supervision level.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Qualifying circumstances that add units<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Qualifying circumstance codes are add-on codes for conditions that make anesthesia harder to deliver. They are reported alongside 00926 and never on their own.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Add-on code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Qualifying circumstance<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Units (ASA RVG)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99100<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Patient of extreme age, under 1 year or over 70<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">1<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99116<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia complicated by total body hypothermia<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">5<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99135<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia complicated by controlled hypotension<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">5<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99140<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia complicated by emergency conditions, specified<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">2<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">99100 is the one to check on a 00926 case, since open urethral repair is common in older men. 99140 applies only where the record documents why the case was an emergency.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare does not pay separately for qualifying circumstance codes. Many commercial payers do recognize them, so confirm the contract before you count those units in an expected-payment figure.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">ICD-10 codes commonly billed with 00926<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every 00926 claim needs a supporting ICD-10 diagnosis code that establishes medical necessity. For radical orchiectomy (inguinal), the diagnosis is almost always testicular malignancy. Urethral stricture and fistula codes turn up more often in urology practices. Below are the pairings billers see most often.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Typical procedure<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">C62.90<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malignant neoplasm of testis, unspecified, unspecified whether descended or undescended<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Radical orchiectomy (inguinal)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">C62.91<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malignant neoplasm of right testis, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Radical orchiectomy (inguinal), right<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">C62.92<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malignant neoplasm of left testis, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Radical orchiectomy (inguinal), left<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">D29.20<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Benign neoplasm of unspecified testis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Orchiectomy for benign mass<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N35.919<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified urethral stricture, male, unspecified site<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open urethral repair or reconstruction<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N36.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Urethral fistula<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open urethral fistula repair<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Laterality matters for testicular malignancy codes. Use C62.91 for the right testis and C62.92 for the left. Submitting C62.90 (unspecified laterality) when the operative report clearly documents right or left is a documentation mismatch that some payers flag during audits. Select the most specific code supported by the physician&rsquo;s documentation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC Codify<\/a> tool carries CPT-to-ICD-10 crosswalk data for 00926 and its neighbors. That helps when you need to validate medical necessity for a specific payer.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Related anesthesia codes in the 00920 series<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 00926 sits in the 00920-00938 range, which covers anesthesia for procedures on the male genitalia. Code 00940 starts the vaginal-procedure block of the same perineum family, 00902-00952. Selecting the right code inside this section means matching the procedure the surgeon performed rather than the general body site. The table below shows the codes most often confused with 00926.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Procedure description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Base units<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">00920<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on male genitalia, not otherwise specified<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">3<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">00926<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on male genitalia; including open urethral procedures; radical orchiectomy, inguinal<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\"><strong>4<\/strong><\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">00928<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on male genitalia; radical orchiectomy, abdominal<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">6<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">00930<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on male genitalia; orchiopexy, unilateral or bilateral<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">4<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\"><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00932\/\">00932<\/a><\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for complete amputation of penis<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The most common coding error in this section is defaulting to 00920 (3 base units) when the procedure qualifies for 00926 (4 base units). A radical orchiectomy via the inguinal approach is named in 00926&rsquo;s descriptor, so 00920 understates the service by one base unit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">At the 2026 Medicare conversion factor that is roughly $20 per case, or about $2,000 across 100 cases.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One unit is not a revenue emergency. The stronger argument for getting the code right is the descriptor. A claim that names the wrong procedure is harder to defend in an audit than one that is short a single unit. Commercial conversion factors also run above Medicare, so the shortfall grows on those claims.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The surgical approach decides between 00926 and 00928. An inguinal orchiectomy is 00926 at 4 base units, while an abdominal orchiectomy is 00928 at 6. That 3-unit spread against 00920 is the one worth catching, and it turns on a single line in the operative note.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Documentation requirements and common denial reasons<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Anesthesia claims face a higher documentation burden than most other CPT codes. The anesthesia record must support every component of the billing formula: base units, time units, physical status, and provider identity. Missing any of these creates an exposure that payers will exploit on a post-payment audit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Required elements for a complete CPT 00926 claim record include the following. Using digital anesthesia forms that auto-capture these data points at the point of care reduces the risk of omissions that only surface at claim review.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-00926\/digital-forms.webp\" alt=\"Pabau digital form builder used to capture anesthesia record fields\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&rsquo;s digital forms can require anesthesia start time, stop time, and physical status before the record closes.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>Anesthesia start time and stop time (exact, to the minute)<\/li><li>Patient physical status classification (P1-P6) documented by the anesthesia provider<\/li><li>Identity and credentials of the anesthesia provider (anesthesiologist, CRNA, or both)<\/li><li>Supervision arrangement clearly documented (if billing QK\/QX or QY)<\/li><li>The specific surgical procedure performed (radical orchiectomy inguinal or open urethral procedure)<\/li><li>ICD-10 diagnosis code supported by physician documentation in the same episode<\/li><li>Signed attestation from the anesthesia provider confirming service delivery<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Maintaining protected health information standards throughout the documentation chain is not optional. Anesthesia records contain sensitive clinical data subject to HIPAA Privacy and Security Rules. Audits can arrive years later.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The most common denial reasons for 00926 claims break into four categories.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Denial reason<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Root cause<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Prevention<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Missing modifier<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No AA, QK, QX, or QZ modifier on the claim<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Build the modifier into the claim template and validate before submission<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Incorrect time units<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Minutes recorded incorrectly, or an arithmetic error in unit conversion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Auto-calculate time units from exact start\/stop times in the billing system<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Mismatched ICD-10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Diagnosis code does not support medical necessity or lacks laterality<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cross-reference the operative note before selecting the ICD-10 code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Supervision not documented<\/td>\n<td style=\"padding:12px 16px;color:#374151\">QK billed but documentation does not confirm concurrent case oversight<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Document all concurrent case activity in the anesthesia record at case end<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The National Correct Coding Initiative (NCCI) edits also apply to anesthesia claims. Review them whenever 00926 shares a claim date with another anesthesia or surgical code. A urologic case that also involves 00912 is the common example. Anesthesia NCCI rules are their own set.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Audit a sample of 00926 claims quarterly. Pull 10 claims and work through three checks. Does the modifier match the documented supervision arrangement? Do the time units match the start and stop times? Does the ICD-10 code match the laterality in the operative note? Most denial patterns surface in the first review.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Related CPT codes<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00940\/\">CPT code 00940 \u2014 Anesthesia for vaginal procedures<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00930\/\">CPT Code 00930 \u2014 Anesthesia for orchiopexy and male genitalia procedures<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00934\/\">CPT code 00934 \u2014 Radical penectomy anesthesia<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">How Pabau supports anesthesia billing workflows<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Anesthesia billing has more moving parts per claim than most specialties. Each claim needs time tracking, modifier selection, physical status classification, an ICD-10 crosswalk, and a payer-specific conversion factor. When any of those steps relies on manual entry, errors compound quickly.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps those steps in one record. Its <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> supports structured claim preparation for procedure-based specialties, including anesthesia. Four things matter most for practices billing 00926 regularly.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-00926\/automate-claims-through-healthcode.webp\" alt=\"Pabau claims management screen showing automated claim submission\"\/><figcaption class=\"wp-element-caption\"><em>Pabau submits claims straight from the case record, so the modifier and the anesthesia times travel with the 00926 claim.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Structured documentation capture:<\/strong> Digital forms can require anesthesia start time, stop time, and physical status before the record closes. Incomplete documentation never reaches the billing queue.<\/li><li><strong>Modifier validation:<\/strong> Claim rules can be configured to flag claims where the anesthesia modifier is absent or inconsistent with the documented provider role.<\/li><li><strong>ICD-10 code mapping:<\/strong> Pabau supports diagnosis code entry at the case level. Billers can cross-reference the operative note and pick the laterality-specific code, C62.91 or C62.92, before submission.<\/li><li><strong>Audit trail:<\/strong> Every edit to a claim record is timestamped and attributed, giving practices a defensible audit trail if a payer requests supporting documentation post-payment.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practices managing anesthesia billing alongside surgical coordination also benefit from integrated scheduling and EHR integration. That keeps the case record, the anesthesia documentation, and the claim in one system instead of three disconnected tools.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For teams working across multiple locations or payers, a single platform removes most of the manual reconciliation. Re-keying the same figures by hand is where much anesthesia record documentation goes wrong.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Submit cleaner anesthesia claims first time                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&rsquo;s claims management software captures anesthesia times, physical status, and modifiers in the case record, then carries them into the claim. Your billing team spends less time reworking 00926 denials.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau practice management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 00926 is straightforward to describe and easy to bill badly. The base-unit difference against 00920 is a single unit, so choosing the right code is a question of accuracy first and revenue second. What carries the payment is anesthesia time. What stops it is a missing modifier, or an ICD-10 code that does not match the operative note.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So put the check in the workflow rather than in the memory of whoever codes that day. Confirm the surgical approach in the operative note, record start and stop times to the minute, and match the physical status modifier to the record. Those three habits cover most of the money at stake.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau gives anesthesia billing teams one place to capture the required documentation fields, validate modifiers, and submit cleaner claims. If 00926 denials are a pattern in your practice, tighter practice management software is the lever to pull. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau handles anesthesia billing.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding an orchiopexy instead?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00930\/\">CPT 00930<\/a> sets out the anesthesia code for unilateral and bilateral orchiopexy, with its base units and modifiers.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Working across the wider perineum family?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00902\/\">CPT 00902<\/a> explains how anesthesia for perineum procedures is coded, documented, and paid.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the surgical side of a testicular emergency?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-54600\/\">CPT 54600<\/a> covers reduction of testicular torsion, from operative documentation through to reimbursement.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing the imaging that comes before surgery?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-76870\/\">CPT 76870<\/a> covers scrotal ultrasound, including the diagnoses that support medical necessity.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Documenting the exam behind the diagnosis?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/cremasteric-reflex\/\">Cremasteric reflex<\/a> explains how to elicit the reflex and what an absent response means.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1785497515939\"><h3 class=\"schema-faq-question\">What is CPT code 00926?<\/h3> <p class=\"schema-faq-answer\">CPT code 00926 is an anesthesia code covering procedures on the male genitalia, specifically radical orchiectomy via the inguinal approach and open urethral procedures. It carries 4 anesthesia base units, and it is billed with the standard anesthesia formula. That formula is (base units + time units) multiplied by the payer&rsquo;s conversion factor.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497515940\"><h3 class=\"schema-faq-question\">How many base units does CPT 00926 have?<\/h3> <p class=\"schema-faq-answer\">CPT 00926 has 4 anesthesia base units. The American Society of Anesthesiologists (ASA) Relative Value Guide and the CMS anesthesia base unit file both list 4. Base units reflect the inherent complexity of the anesthesia service. They are added to time units before multiplying by the payer&rsquo;s conversion factor.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497515941\"><h3 class=\"schema-faq-question\">What modifiers are used with CPT code 00926?<\/h3> <p class=\"schema-faq-answer\">CPT 00926 requires both an anesthesia provider modifier and a physical status modifier on every claim. Provider modifiers include AA (personally performed by anesthesiologist), QK (medical direction of 2-4 CRNAs), and QX (CRNA under medical direction). QY covers medical direction of one CRNA, and QZ covers an independent CRNA. Physical status modifiers run from P1 (normal healthy patient) through P5 (moribund patient).<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497515942\"><h3 class=\"schema-faq-question\">What ICD-10 codes are billed with CPT 00926?<\/h3> <p class=\"schema-faq-answer\">The most common ICD-10 codes billed with 00926 are C62.91 (malignant neoplasm of right testis) and C62.92 (left testis) for radical orchiectomy. For open urethral procedures, use N35.919 (urethral stricture) or N36.0 (urethral fistula). Always select the most specific laterality code supported by the operative documentation.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497515943\"><h3 class=\"schema-faq-question\">Can a CRNA bill CPT code 00926 independently?<\/h3> <p class=\"schema-faq-answer\">A CRNA can bill 00926 independently using modifier QZ, but only in states that have opted out of Medicare physician supervision requirements. The payer&rsquo;s policy also has to permit independent CRNA billing. Most commercial payers follow state supervision laws, though some add contract-specific requirements. Confirm both before billing independently.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497515944\"><h3 class=\"schema-faq-question\">What is the difference between CPT 00926 and CPT 00920?<\/h3> <p class=\"schema-faq-answer\">CPT 00920 is the general \u00ab\u00a0not otherwise specified\u00a0\u00bb code for male genitalia anesthesia and carries 3 base units. CPT 00926 covers radical orchiectomy (inguinal) and open urethral procedures, and it carries 4 base units. Billing 00920 for a radical orchiectomy understates the claim by one unit, about $20 at 2026 Medicare rates. Select 00926 whenever the operative report documents either of its listed procedures.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497515945\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for CPT 00926?<\/h3> <p class=\"schema-faq-answer\">Medicare pays (base units + time units) multiplied by the anesthesia conversion factor, which is $20.4976 nationally for 2026. Qualifying APM participants are paid at $20.5998 per unit. A 60-minute 00926 case carries 4 base units and 4 time units, so it comes to about $163.98 before geographic adjustment. Geographic Practice Cost Indices (GPCI) then adjust the rate by locality.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT code 00926 covers anesthesia for procedures on the male genitalia, specifically radical orchiectomy through an inguinal approach and open urethral procedures. It carries 4 anesthesia base units. Payment is the sum of base units and time units, multiplied by the payer&rsquo;s conversion factor. This guide covers the official descriptor, the 2026 Medicare rates, and [&hellip;]<\/p>\n","protected":false},"author":81,"featured_media":170809,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[4162,1236,2559,2538],"class_list":["post-170811","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-anesthesia-billing","tag-medicare-reimbursement","tag-urology-billing","tag-urology-coding"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT code 00926: Base units, modifiers, and 2026 rates<\/title>\n<meta name=\"description\" content=\"CPT 00926 carries 4 base units and pays about $164 for a 60-minute case, one unit more than 00920 at 2026 Medicare rates.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT code 00926: Base units, modifiers, and 2026 rates\" \/>\n<meta property=\"og:description\" content=\"CPT 00926 carries 4 base units and pays about $164 for a 60-minute case, one unit more than 00920 at 2026 Medicare rates.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-07-31T13:11:01+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-17T11:41:15+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/07\/cpt-code-00926.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Aleksandar Kochovski\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Aleksandar Kochovski\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta 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is an all-in-one healthcare practice management software platform designed for clinics, medspas, therapists, and medical professionals. It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/73b672a49e20bfba8161e3c17ee3dda2\",\"name\":\"Aleksandar Kochovski\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg\",\"caption\":\"Aleksandar Kochovski\"},\"description\":\"Aleksandar is a content strategist and editor working in tech publishing, with a background in higher education. He specializes in topics around compliance in software solutions. When he's not writing at Pabau, you can find him tending to his bonsai collection or hitting the gym.\",\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/blog\\\/author\\\/aleksandar-kochovski\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515939\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515939\",\"name\":\"What is CPT code 00926?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT code 00926 is an anesthesia code covering procedures on the male genitalia, specifically radical orchiectomy via the inguinal approach and open urethral procedures. It carries 4 anesthesia base units, and it is billed with the standard anesthesia formula. That formula is (base units + time units) multiplied by the payer's conversion factor.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515940\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515940\",\"name\":\"How many base units does CPT 00926 have?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 00926 has 4 anesthesia base units. The American Society of Anesthesiologists (ASA) Relative Value Guide and the CMS anesthesia base unit file both list 4. Base units reflect the inherent complexity of the anesthesia service. They are added to time units before multiplying by the payer's conversion factor.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515941\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515941\",\"name\":\"What modifiers are used with CPT code 00926?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 00926 requires both an anesthesia provider modifier and a physical status modifier on every claim. Provider modifiers include AA (personally performed by anesthesiologist), QK (medical direction of 2-4 CRNAs), and QX (CRNA under medical direction). QY covers medical direction of one CRNA, and QZ covers an independent CRNA. Physical status modifiers run from P1 (normal healthy patient) through P5 (moribund patient).\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515942\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515942\",\"name\":\"What ICD-10 codes are billed with CPT 00926?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The most common ICD-10 codes billed with 00926 are C62.91 (malignant neoplasm of right testis) and C62.92 (left testis) for radical orchiectomy. For open urethral procedures, use N35.919 (urethral stricture) or N36.0 (urethral fistula). Always select the most specific laterality code supported by the operative documentation.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515943\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515943\",\"name\":\"Can a CRNA bill CPT code 00926 independently?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"A CRNA can bill 00926 independently using modifier QZ, but only in states that have opted out of Medicare physician supervision requirements. The payer's policy also has to permit independent CRNA billing. Most commercial payers follow state supervision laws, though some add contract-specific requirements. Confirm both before billing independently.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515944\",\"position\":6,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515944\",\"name\":\"What is the difference between CPT 00926 and CPT 00920?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 00920 is the general \\\"not otherwise specified\\\" code for male genitalia anesthesia and carries 3 base units. CPT 00926 covers radical orchiectomy (inguinal) and open urethral procedures, and it carries 4 base units. Billing 00920 for a radical orchiectomy understates the claim by one unit, about $20 at 2026 Medicare rates. Select 00926 whenever the operative report documents either of its listed procedures.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515945\",\"position\":7,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-00926\\\/#faq-question-1785497515945\",\"name\":\"What is the Medicare reimbursement rate for CPT 00926?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Medicare pays (base units + time units) multiplied by the anesthesia conversion factor, which is $20.4976 nationally for 2026. Qualifying APM participants are paid at $20.5998 per unit. A 60-minute 00926 case carries 4 base units and 4 time units, so it comes to about $163.98 before geographic adjustment. 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is an all-in-one healthcare practice management software platform designed for clinics, medspas, therapists, and medical professionals. It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.","foundingDate":"2011-10-20","numberOfEmployees":{"@type":"QuantitativeValue","minValue":"201","maxValue":"500"}},{"@type":"Person","@id":"https:\/\/pabau.com\/fr\/#\/schema\/person\/73b672a49e20bfba8161e3c17ee3dda2","name":"Aleksandar Kochovski","image":{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg","url":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg","contentUrl":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg","caption":"Aleksandar Kochovski"},"description":"Aleksandar is a content strategist and editor working in tech publishing, with a background in higher education. He specializes in topics around compliance in software solutions. When he's not writing at Pabau, you can find him tending to his bonsai collection or hitting the gym.","url":"https:\/\/pabau.com\/fr\/blog\/author\/aleksandar-kochovski\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515939","position":1,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515939","name":"What is CPT code 00926?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 00926 is an anesthesia code covering procedures on the male genitalia, specifically radical orchiectomy via the inguinal approach and open urethral procedures. It carries 4 anesthesia base units, and it is billed with the standard anesthesia formula. That formula is (base units + time units) multiplied by the payer's conversion factor.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515940","position":2,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515940","name":"How many base units does CPT 00926 have?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 00926 has 4 anesthesia base units. The American Society of Anesthesiologists (ASA) Relative Value Guide and the CMS anesthesia base unit file both list 4. Base units reflect the inherent complexity of the anesthesia service. They are added to time units before multiplying by the payer's conversion factor.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515941","position":3,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515941","name":"What modifiers are used with CPT code 00926?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 00926 requires both an anesthesia provider modifier and a physical status modifier on every claim. Provider modifiers include AA (personally performed by anesthesiologist), QK (medical direction of 2-4 CRNAs), and QX (CRNA under medical direction). QY covers medical direction of one CRNA, and QZ covers an independent CRNA. Physical status modifiers run from P1 (normal healthy patient) through P5 (moribund patient).","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515942","position":4,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515942","name":"What ICD-10 codes are billed with CPT 00926?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The most common ICD-10 codes billed with 00926 are C62.91 (malignant neoplasm of right testis) and C62.92 (left testis) for radical orchiectomy. For open urethral procedures, use N35.919 (urethral stricture) or N36.0 (urethral fistula). Always select the most specific laterality code supported by the operative documentation.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515943","position":5,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515943","name":"Can a CRNA bill CPT code 00926 independently?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"A CRNA can bill 00926 independently using modifier QZ, but only in states that have opted out of Medicare physician supervision requirements. The payer's policy also has to permit independent CRNA billing. Most commercial payers follow state supervision laws, though some add contract-specific requirements. Confirm both before billing independently.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515944","position":6,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515944","name":"What is the difference between CPT 00926 and CPT 00920?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 00920 is the general \"not otherwise specified\" code for male genitalia anesthesia and carries 3 base units. CPT 00926 covers radical orchiectomy (inguinal) and open urethral procedures, and it carries 4 base units. Billing 00920 for a radical orchiectomy understates the claim by one unit, about $20 at 2026 Medicare rates. Select 00926 whenever the operative report documents either of its listed procedures.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515945","position":7,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-00926\/#faq-question-1785497515945","name":"What is the Medicare reimbursement rate for CPT 00926?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Medicare pays (base units + time units) multiplied by the anesthesia conversion factor, which is $20.4976 nationally for 2026. Qualifying APM participants are paid at $20.5998 per unit. A 60-minute 00926 case carries 4 base units and 4 time units, so it comes to about $163.98 before geographic adjustment. Geographic Practice Cost Indices (GPCI) then adjust the rate by locality.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"}]}},"yoast":{"focus_keyword":"CPT code 00926","seo_title":"CPT code 00926: Base units, modifiers, and 2026 rates","meta_description":"CPT 00926 carries 4 base units and pays about $164 for a 60-minute case, one unit more than 00920 at 2026 Medicare rates.","content_score":"90","is_cornerstone":"","related_keyphrases":[{"keyword":"anesthesia base units billing","score":61},{"keyword":"CPT 00926 modifiers","score":72},{"keyword":"radical orchiectomy anesthesia billing","score":61}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts\/170811","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/users\/81"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/comments?post=170811"}],"version-history":[{"count":5,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts\/170811\/revisions"}],"predecessor-version":[{"id":181776,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts\/170811\/revisions\/181776"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/media\/170809"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/media?parent=170811"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/categories?post=170811"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/tags?post=170811"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}