{"id":163329,"date":"2026-07-27T11:53:30","date_gmt":"2026-07-27T11:53:30","guid":{"rendered":"https:\/\/pabau.com\/?p=163329"},"modified":"2026-08-17T11:35:42","modified_gmt":"2026-08-17T11:35:42","slug":"cpt-code-00402","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-00402\/","title":{"rendered":"CPT Code 00402: Anesthesia for reconstructive breast procedures"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 00402: Anesthesia for Reconstructive Breast Procedures\",\"description\":\"CPT Code 00402 covers anesthesia for reconstructive procedures on the breast, such as reduction or augmentation mammoplasty and muscle flap reconstruction. Learn base units, modifiers, and 2026 Medicare reimbursement rates.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00402\/\",\"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\":\"2026-01-28\",\"dateModified\":\"2026-01-28\"}<\/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 00402 describes anesthesia for reconstructive procedures on the breast, such as reduction or augmentation mammoplasty and muscle flap reconstruction.<\/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 5 anesthesia base units, and total payment equals (base units + time units) multiplied by the 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>Common billing errors include omitting required modifiers (AA, QK, QX) and confusing 00402 with the radical breast procedure codes 00404 and 00406.<\/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>Pabau&#8217;s claims management software supports anesthesia billing workflows, helping practices track CPT codes, modifiers, and documentation requirements.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT Code 00402 is the anesthesia code for reconstructive procedures on the breast, such as reduction or augmentation mammoplasty and muscle flap reconstruction. It carries a base unit value of 5, sits within the thorax\/breast anesthesia code family (00400-00406), and is billed using anesthesia&#8217;s time-based payment formula rather than a flat fee.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This reference covers the official code description, billing formula, applicable modifiers, 2026 Medicare reimbursement context, qualifying circumstance add-on codes, and the documentation pitfalls that create audit exposure.<\/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\"><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><\/figure>\n\n\n\n<h2 id=\"h-what-is-cpt-code-00402\" class=\"wp-block-heading\">What is CPT Code 00402?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 00402 is the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">AMA-maintained<\/a> anesthesia code for reconstructive procedures on the breast, such as reduction or augmentation mammoplasty and muscle flap reconstruction. It sits within the thorax (chest wall and shoulder girdle) anesthesia code range and falls within the broader anesthesia section of the CPT code set, which covers codes 00100 through 01999.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Although 00402 sits in the CPT range labeled for the integumentary system on the extremities, anterior trunk, and perineum, its specific descriptor is narrower: it applies only to reconstructive breast procedures, such as reduction mammoplasty, augmentation mammoplasty, and muscle flap reconstruction (for example, latissimus dorsi or TRAM flap).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It does not apply to general skin or soft-tissue procedures on the extremities, anterior trunk, or perineum, which use 00400 when no other code applies, or to radical or modified radical breast procedures such as mastectomy, which use 00404 or 00406 instead. Surgeries on the back, head, or neck use different anesthesia codes, such as 00300.<\/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\">Field<\/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\">Details<\/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\">Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">00402<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official description<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; reconstructive procedures on breast (e.g., reduction or augmentation mammoplasty, muscle flaps)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia (00100-01999)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Base units<\/td>\n<td style=\"padding:12px 16px;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\">Anatomical scope<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Breast (reconstructive procedures); code family also spans extremities, anterior trunk, perineum<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Payment model<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Time-based: base units + time units x conversion factor<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-cpt-code-00402-anesthesia-base-units-and-billing-formula\" class=\"wp-block-heading\">CPT Code 00402: Anesthesia base units and billing formula<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Anesthesia reimbursement does not work like a standard procedure code. Instead of a flat RVU, payment is calculated using a formula that combines a fixed base unit value with time-based units. For 00402 (reconstructive breast procedures), the base unit value is 5, as confirmed by <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC&#8217;s CPT code reference<\/a> and FindACode&#8217;s published base unit table.<\/p>\n\n\n\n<h3 id=\"h-the-anesthesia-billing-formula\" class=\"wp-block-heading\">The anesthesia billing formula<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The standard anesthesia billing formula, used by <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS and commercial payers<\/a>, is:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Total Units = Base Units + Time Units<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Payment = Total Units x Anesthesia Conversion Factor<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Time units are typically counted in 15-minute increments: each 15 minutes of anesthesia time equals one time unit. A 45-minute procedure would add 3 time units. For a patient under 00402 at 45 minutes, total units = 5 (base) + 3 (time) = 8. Multiply by the applicable conversion factor to arrive at the payment amount.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The CMS anesthesia conversion factor is updated annually. Because geographic locality adjustments also apply, the final reimbursement varies by provider location. Always confirm the current-year conversion factor via the <a href=\"https:\/\/fastrvu.com\/tools\/rvu-lookup\" target=\"_blank\" rel=\"nofollow noopener\">FastRVU RVU lookup tool<\/a> or the CMS Physician Fee Schedule before billing.<\/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\">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\">Value \/ Rule<\/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\">Notes<\/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 (00402)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">5<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fixed; set by CMS and ASA Relative Value Guide<\/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<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1 unit per 15 minutes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Some payers use different increments; confirm per payer policy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Conversion factor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Updated annually by CMS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Geographic locality adjustments apply; confirm current year rate<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Formula<\/td>\n<td style=\"padding:12px 16px;color:#374151\">(Base + Time) x CF<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Standard for Medicare and most commercial payers<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-cpt-code-00402-modifiers\" class=\"wp-block-heading\">CPT Code 00402 modifiers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Anesthesia modifiers define who provided the anesthesia service and under what supervision arrangement. Every 00402 claim requires at least one anesthesia modifier. Submitting without one is a common denial trigger. Modifier selection depends on whether an anesthesiologist personally performed the service, supervised a CRNA, or co-managed care with a CRNA.<\/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\">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\">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 personally performed by anesthesiologist<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesiologist is physically present and personally provides all anesthesia care<\/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 two to four CRNAs<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesiologist is medically directing 2-4 concurrent CRNA 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 with medical direction by a physician<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Used by the CRNA when under medical direction of an anesthesiologist<\/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\">Anesthesiologist is directing a single CRNA case<\/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 without medical direction<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CRNA is providing services independently, without physician medical direction<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">AD<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medical supervision by physician, more than four CRNAs<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesiologist is supervising more than four concurrent CRNA cases; reduced payment rate applies<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G8<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Monitored anesthesia care (MAC) for deep complex procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">MAC services for procedures on the list published by CMS<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">MAC for patients with documented medical conditions<\/td>\n<td style=\"padding:12px 16px;color:#374151\">MAC where medical condition (not procedure complexity) justifies it; must be documented<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Monitored anesthesia care (MAC) billing under 00402 follows its own documentation requirements per CMS MAC policy (Article A57361). MAC cannot be billed simply because the patient preferred it. Medical necessity must be documented in the anesthesia record. Conflating MAC with general anesthesia billing is a documented audit trigger.<\/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 your modifier mix before submitting 00402 claims in bulk. If AA and QK appear on claims for the same anesthesiologist on the same date, verify that the concurrent case count actually supports QK. CMS reviewers flag providers whose modifier patterns do not align with their reported case volume.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-reimbursement-and-2026-fee-schedule\" class=\"wp-block-heading\">Reimbursement and 2026 fee schedule<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Anesthesia reimbursement under Medicare is not a flat fee. CMS publishes an annual anesthesia conversion factor, and localities apply geographic practice cost index (GPCI) adjustments on top of that. Two practices billing the identical 00402 claim for a 30-minute procedure can receive different payments based solely on their location.<\/p>\n\n\n\n<h3 id=\"h-medicare-reimbursement-for-00402\" class=\"wp-block-heading\">Medicare reimbursement for 00402<\/h3>\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-00402\/track-claims-from-start-to-finish.webp\" alt=\"Track claims from start to Finish\"\/><figcaption class=\"wp-element-caption\"><em>Track claims from start to finish with Pabau.<\/em><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">For 2026, the CMS anesthesia conversion factor should be confirmed against the official CMS Physician Fee Schedule before billing, as rates change each January 1. Geographic adjustments mean that a provider in a high-cost urban area will receive more per unit than a provider in a rural area billing the same code. Always verify the current-year locality-adjusted rate for your MAC region.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial payer rates for 00402 typically exceed Medicare rates, though they vary significantly by contract. Some payers carve out anesthesia billing to specialty RCM vendors, which introduces additional modifier and documentation requirements. Confirm each payer&#8217;s specific conversion factor and time-unit conventions before submitting. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that manage billing in-house benefit from tracking these payer-by-payer variations in a structured way, which is where <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> earns its keep.<\/p>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\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\">Payer 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\">Conversion factor source<\/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\">Rate notes<\/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\">Medicare<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS annual fee schedule<\/td>\n<td style=\"padding:12px 16px;color:#374151\">GPCI-adjusted by locality; confirm current year at cms.gov<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicaid<\/td>\n<td style=\"padding:12px 16px;color:#374151\">State-specific; varies widely<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Some states use Medicare rate; others use independent conversion factors<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Commercial<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Contracted rate per payer agreement<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Often higher than Medicare; verify per contract<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\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                    Manage anesthesia claims with less manual effort                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&#8217;s claims management tools help surgical and procedural practices track CPT codes, modifiers, and payer-specific billing rules in one place. See how it works for your team.                <\/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 claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-icd-10-diagnosis-codes-used-with-cpt-code-00402\" class=\"wp-block-heading\">ICD-10 diagnosis codes used with CPT Code 00402<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medical necessity for 00402 is established by pairing the anesthesia code with the appropriate ICD-10-CM diagnosis code from the reconstructive breast procedure being supported. The diagnosis code should reflect the condition requiring the procedure, not the anesthesia itself. Below are commonly reported ICD-10 codes alongside 00402, grouped by procedure category.<\/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 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\">Procedure context<\/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\">Z42.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for breast reconstruction following mastectomy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Post-mastectomy reconstruction using flap or implant-based technique<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z90.11<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acquired absence of right breast and nipple<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unilateral (right-side) reconstruction following prior mastectomy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z90.12<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acquired absence of left breast and nipple<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unilateral (left-side) reconstruction following prior mastectomy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z90.13<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acquired absence of bilateral breasts and nipples<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral reconstruction following prior bilateral mastectomy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N62<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hypertrophy of breast<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reduction mammoplasty for symptomatic macromastia<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">C50.911<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malignant neoplasm of unspecified site of right female breast<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Immediate reconstruction performed at the time of mastectomy<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">This table reflects commonly accepted pairings, not an exhaustive list. Verify medical necessity for each specific case and confirm payer crosswalk requirements. Using an ICD-10 code that does not align with the documented reconstructive procedure is a common denial driver. Good medical forms help capture the right diagnostic information before the procedure rather than reconstructing it at billing time.<\/p>\n\n\n\n<h2 id=\"h-related-anesthesia-cpt-codes\" class=\"wp-block-heading\">Related anesthesia CPT codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">00402 sits within the thorax\/breast anesthesia code family (00400-00406). Selecting the wrong code from this group accounts for a material share of anesthesia coding errors, particularly when a reconstructive breast procedure is coded as a radical or modified radical procedure (00404 or 00406), or vice versa. For a broader overview of other procedural CPT codes, see the related reference pages.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Other frequently billed anesthesia codes include 00932 for penile procedures and 01710 for upper-arm soft-tissue procedures, each carrying its own base unit value.<\/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\">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\">Base units<\/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 instead of 00402<\/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\">00400<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">3<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Minor superficial integumentary procedures on the extremities, anterior trunk, or perineum that are not breast 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\">00404<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for radical or modified radical procedures on breast<\/td>\n<td style=\"padding:12px 16px;color:#374151\">5<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Mastectomy or other radical\/modified radical breast procedures, as opposed to reconstructive procedures<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">00406<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for radical or modified radical procedures on breast with internal mammary node dissection<\/td>\n<td style=\"padding:12px 16px;color:#374151\">13<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Radical mastectomy with internal mammary node dissection; higher complexity than 00404<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">00300<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for procedures on head, neck, and posterior trunk<\/td>\n<td style=\"padding:12px 16px;color:#374151\">5<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Procedures on posterior trunk or head\/neck integumentary system, outside 00402&#8217;s breast scope<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Practices specializing in reconstructive and cosmetic breast procedures, including those supporting plastic surgery practice management or running med spa software, need a reliable process for distinguishing 00402 from the radical and modified radical breast codes (00404, 00406) at point-of-documentation rather than at billing reconciliation.<\/p>\n\n\n\n<h2 id=\"h-qualifying-circumstance-codes-with-00402\" class=\"wp-block-heading\">Qualifying circumstance codes with 00402<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Qualifying circumstance codes are add-on codes that may be reported in addition to 00402 when specific patient or procedural conditions exist. These codes carry their own base unit values and must be supported by documentation that confirms the qualifying condition was present and clinically relevant.<\/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\">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\">Additional 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\">99100<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Anesthesia for patient of extreme age (younger than 1 year or 70 years and older)<\/td>\n<td style=\"padding:12px 16px;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\">99116<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Utilization of total body hypothermia during anesthesia<\/td>\n<td style=\"padding:12px 16px;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\">Controlled hypotension during anesthesia<\/td>\n<td style=\"padding:12px 16px;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\">Emergency conditions (patient&#8217;s condition creates significant risk)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">+5<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Payer policies on qualifying circumstance codes vary. Some commercial payers do not reimburse for 99100 or 99116 without prior authorization or explicit policy language. Confirm per-payer eligibility before billing. Overstating these add-on codes in the absence of documentation is an overpayment risk and an audit flag.<\/p>\n\n\n\n<h2 id=\"h-common-billing-errors-and-compliance-tips\" class=\"wp-block-heading\">Common billing errors and compliance tips<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Anesthesia claims are audited more frequently than most procedure types because the time-based formula and modifier requirements create multiple points of failure. These are the errors that appear most often in anesthesia billing reviews.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Missing or incorrect modifier:<\/strong> Submitting 00402 without an anesthesia modifier (AA, QK, QX, QY, QZ) guarantees a denial. Incorrect modifier selection (for example, using AA when the anesthesiologist was directing four concurrent CRNA cases) creates overpayment exposure under False Claims Act risk.<\/li>\n\n\n\n<li><strong>Inaccurate time documentation:<\/strong> Anesthesia time must be documented from induction start to emergence, not from procedure start to finish. A 10-minute discrepancy in recorded time changes the unit count and the reimbursement.<\/li>\n\n\n\n<li><strong>Wrong procedure code within the breast\/thorax family:<\/strong> Billing 00402 for a posterior trunk procedure (which maps to 00300) or for a mastectomy\/radical breast procedure (which maps to 00404 or 00406) results in a denied or down-coded claim. The operative note must clearly state whether the procedure was reconstructive (00402) or radical\/modified radical (00404, 00406).<\/li>\n\n\n\n<li><strong>Unsupported qualifying circumstance codes:<\/strong> Billing 99100 without documenting the patient&#8217;s age in the anesthesia record, or billing 99140 without documenting the emergency condition, creates both a denial risk and an audit trail problem.<\/li>\n\n\n\n<li><strong>ICD-10 mismatch:<\/strong> The diagnosis code must reflect the condition requiring the surgical procedure, not a generic anesthesia indication. Claims that link 00402 to a diagnosis not supported by the operative documentation are denied for medical necessity.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Good HIPAA compliance practices intersect directly with anesthesia billing: the anesthesia record, operative note, and claim must tell a consistent story. When documentation lives in disconnected systems, reconstructing that consistency at audit time becomes expensive. A HIPAA compliance checklist for your billing team can help catch missing documentation before a payer review does.<\/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>Build a pre-submission checklist for 00402 claims: verify modifier, confirm anesthesia start and stop times in the record, cross-check the anatomical site against the operative note, and confirm the ICD-10 code matches the documented procedure indication. A five-minute pre-submission review catches the errors that take days to correct in appeals.<\/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-00400\/\">CPT code 00400 \u2014 Anesthesia for integumentary system procedures<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00404\/\">CPT code 00404 \u2014 Anesthesia for radical mastectomy procedures<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00410\/\">CPT Code 00410 \u2014 Anesthesia for electrical conversion of arrhythmias<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00450\/\">CPT Code 00450 \u2014 Anesthesia for clavicle and scapula procedures<\/a><\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-how-pabau-supports-anesthesia-billing-documentation\" class=\"wp-block-heading\">How Pabau supports anesthesia billing documentation<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Billing accuracy for codes like 00402 depends on documentation quality, not just coding knowledge. When the anesthesia record, operative note, and claim data exist in separate systems, discrepancies compound silently until a denial or audit surfaces them.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s claims management software gives surgical and procedural practices a single location for tracking CPT codes, modifier assignments, and the supporting documentation that payers expect. Rather than reconciling records after the fact, the workflow connects intake, clinical notes, and billing before the claim goes out. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices focused on simplifying practice management find that this connected approach reduces the back-and-forth with billing teams on missing modifier data.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For practices that handle surgical referrals or multi-provider anesthesia arrangements. The practice management features that matter most for anesthesia billing are those that keep what the clinician documented in sync with what the biller submits.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices handling large patient volumes also benefit from thinking through their broader patient data security tools alongside billing workflows, since claim data and PHI often move through the same systems.<\/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-00402\/comprehensive-emr-patient-record-management.webp\" alt=\"Comprehensive EMR &amp; patient record management\"\/><figcaption class=\"wp-element-caption\"><em>Comprehensive EMR &amp; patient record management<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">For practices that also use digital forms to capture pre-procedure intake, the documentation chain that supports 00402 medical necessity can be completed before the patient enters the OR rather than reconstructed afterward. The HIPAA compliance requirements that govern anesthesia records apply to digital intake data as well, so an integrated system reduces the compliance surface area compared to managing paper forms separately.<\/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-00402\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Customizable consent and intake forms<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 00402 is a five-base-unit anesthesia code for reconstructive breast procedures, with a billing formula, modifier set, and documentation requirements that differ fundamentally from standard procedure billing. The most costly errors, confusing 00402 with the radical breast procedure codes (00404, 00406), modifier omission, and anesthesia time miscalculation, are preventable with a structured pre-submission review process.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that connect clinical documentation to billing workflows keep what the anesthesiologist recorded and what the claim reflects in sync. If your team wants to see how Pabau handles this end-to-end, <a href=\"https:\/\/pabau.com\/book-demo\/\">book a demo<\/a> and we can walk through the claims and documentation workflow together.<\/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>Billing anesthesia for a different procedure type?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-01924\/\">CPT Code 01924<\/a> covers base units and modifiers for anesthesia during arterial interventional radiology.<\/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>Coding a joint procedure instead?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-20605\/\">CPT Code 20605<\/a> breaks down billing for intermediate joint arthrocentesis.<\/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 a reference for a minor surgical procedure?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-10081\/\">CPT Code 10081<\/a> covers incision and drainage of a complicated pilonidal cyst.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" 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-1784874543343\"><h3 class=\"schema-faq-question\">What is CPT Code 00402 used for?<\/h3> <p class=\"schema-faq-answer\">CPT Code 00402 is an anesthesia code used to bill anesthesia services for reconstructive procedures on the breast, such as reduction mammoplasty, augmentation mammoplasty, and muscle flap reconstruction. It carries a base unit value of 5 and sits within the thorax (chest wall and shoulder girdle) anesthesia code family (00400-00406).<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784874543344\"><h3 class=\"schema-faq-question\">How many base units does CPT 00402 have?<\/h3> <p class=\"schema-faq-answer\">CPT 00402 has 5 anesthesia base units. Total payment is calculated as (5 base units + time units) multiplied by the applicable anesthesia conversion factor, which CMS updates annually and adjusts by geographic locality.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784874543345\"><h3 class=\"schema-faq-question\">What is the difference between CPT 00400 and CPT 00402?<\/h3> <p class=\"schema-faq-answer\">CPT 00400 is the not-otherwise-specified code for integumentary procedures on the extremities, anterior trunk, and perineum, and carries 3 base units. CPT 00402 is specific to reconstructive procedures on the breast (e.g., reduction or augmentation mammoplasty, muscle flaps) and carries 5 base units. Use 00400 for general integumentary procedures outside the breast, and 00402 only when the procedure is a breast reconstruction.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784874543346\"><h3 class=\"schema-faq-question\">How is CPT 00402 different from CPT 00404 and 00406?<\/h3> <p class=\"schema-faq-answer\">00402, 00404, and 00406 all fall within the same breast anesthesia code family, but they describe different procedure types. 00402 covers reconstructive procedures on the breast, such as reduction or augmentation mammoplasty and muscle flap reconstruction (5 base units). 00404 covers radical or modified radical procedures on the breast, such as mastectomy (5 base units). 00406 covers radical or modified radical breast procedures with internal mammary node dissection, a higher-complexity procedure (13 base units). Billing the wrong one of these three codes is a common cause of denied or down-coded anesthesia claims.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784874543347\"><h3 class=\"schema-faq-question\">Can CPT 00402 be billed with monitored anesthesia care (MAC)?<\/h3> <p class=\"schema-faq-answer\">Yes, but MAC billing requires documented medical necessity per CMS MAC policy (Article A57361). When MAC is provided for a procedure covered by 00402, modifier G8 or G9 is appended to indicate the MAC circumstance. Patient preference alone does not satisfy medical necessity for MAC; the clinical indication must be documented in the anesthesia record.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784874543348\"><h3 class=\"schema-faq-question\">What qualifying circumstance codes apply to CPT 00402?<\/h3> <p class=\"schema-faq-answer\">Four add-on codes may be reported with 00402 when the qualifying condition is documented: 99100 for patients under 1 year or 70 years and older (+5 base units), 99116 for total body hypothermia (+5 units), 99135 for controlled hypotension (+5 units), and 99140 for emergency conditions (+5 units). Payer policies vary; confirm per-payer eligibility before billing any of these add-ons.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784874543349\"><h3 class=\"schema-faq-question\">What ICD-10 diagnosis codes are commonly reported with CPT 00402?<\/h3> <p class=\"schema-faq-answer\">Commonly paired ICD-10 codes include Z42.1 (encounter for breast reconstruction following mastectomy), Z90.11\/Z90.12\/Z90.13 (acquired absence of breast and nipple, unilateral or bilateral), N62 (hypertrophy of breast) for reduction mammoplasty, and C50.911 when reconstruction is performed at the time of mastectomy for breast cancer. The diagnosis code should reflect the condition requiring the reconstructive procedure, not the anesthesia service itself.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT Code 00402 is the anesthesia code for reconstructive procedures on the breast, such as reduction or augmentation mammoplasty and muscle flap reconstruction. It carries a base unit value of 5, sits within the thorax\/breast anesthesia code family (00400-00406), and is billed using anesthesia&#8217;s time-based payment formula rather than a flat fee. This reference covers [&hellip;]<\/p>\n","protected":false},"author":81,"featured_media":163327,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"88","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[1364,4126],"class_list":["post-163329","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-billing","tag-cpt"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.3 (Yoast SEO v28.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT Code 00402: Anesthesia for reconstructive breast procedures<\/title>\n<meta name=\"description\" content=\"CPT Code 00402 covers anesthesia for reconstructive breast procedures like reduction or augmentation mammoplasty.\" \/>\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\/nl\/procedure-codes\/cpt-code-00402\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT Code 00402: Anesthesia for reconstructive breast procedures\" \/>\n<meta property=\"og:description\" content=\"CPT Code 00402 covers anesthesia for reconstructive breast procedures like reduction or augmentation mammoplasty.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-00402\/\" \/>\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\" 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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\\\/nl\\\/#\\\/schema\\\/person\\\/73b672a49e20bfba8161e3c17ee3dda2\",\"name\":\"Aleksandar Kochovski\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"nl-NL\",\"@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\\\/nl\\\/blog\\\/author\\\/aleksandar-kochovski\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-00402\\\/#faq-question-1784874543343\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-00402\\\/#faq-question-1784874543343\",\"name\":\"What is CPT Code 00402 used for?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT Code 00402 is an anesthesia code used to bill anesthesia services for reconstructive procedures on the breast, such as reduction mammoplasty, augmentation mammoplasty, and muscle flap reconstruction. It carries a base unit value of 5 and sits within the thorax (chest wall and shoulder girdle) anesthesia code family (00400-00406).\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-00402\\\/#faq-question-1784874543344\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-00402\\\/#faq-question-1784874543344\",\"name\":\"How many base units does CPT 00402 have?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 00402 has 5 anesthesia base units. Total payment is calculated as (5 base units + time units) multiplied by the applicable anesthesia conversion factor, which CMS updates annually and adjusts by geographic locality.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-00402\\\/#faq-question-1784874543345\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-00402\\\/#faq-question-1784874543345\",\"name\":\"What is the difference between CPT 00400 and CPT 00402?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 00400 is the not-otherwise-specified code for integumentary procedures on the extremities, anterior trunk, and perineum, and carries 3 base units. CPT 00402 is specific to reconstructive procedures on the breast (e.g., reduction or augmentation mammoplasty, muscle flaps) and carries 5 base units. Use 00400 for general integumentary procedures outside the breast, and 00402 only when the procedure is a breast reconstruction.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-00402\\\/#faq-question-1784874543346\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-00402\\\/#faq-question-1784874543346\",\"name\":\"How is CPT 00402 different from CPT 00404 and 00406?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"00402, 00404, and 00406 all fall within the same breast anesthesia code family, but they describe different procedure types. 00402 covers reconstructive procedures on the breast, such as reduction or augmentation mammoplasty and muscle flap reconstruction (5 base units). 00404 covers radical or modified radical procedures on the breast, such as mastectomy (5 base units). 00406 covers radical or modified radical breast procedures with internal mammary node dissection, a higher-complexity procedure (13 base units). 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It carries a base unit value of 5 and sits within the thorax (chest wall and shoulder girdle) anesthesia code family (00400-00406).","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-00402\/#faq-question-1784874543344","position":2,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-00402\/#faq-question-1784874543344","name":"How many base units does CPT 00402 have?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 00402 has 5 anesthesia base units. 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Use 00400 for general integumentary procedures outside the breast, and 00402 only when the procedure is a breast reconstruction.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-00402\/#faq-question-1784874543346","position":4,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-00402\/#faq-question-1784874543346","name":"How is CPT 00402 different from CPT 00404 and 00406?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"00402, 00404, and 00406 all fall within the same breast anesthesia code family, but they describe different procedure types. 00402 covers reconstructive procedures on the breast, such as reduction or augmentation mammoplasty and muscle flap reconstruction (5 base units). 00404 covers radical or modified radical procedures on the breast, such as mastectomy (5 base units). 00406 covers radical or modified radical breast procedures with internal mammary node dissection, a higher-complexity procedure (13 base units). 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