CPT code 00562: Anesthesia for intrathoracic procedures with pump oxygenator

Key Takeaways

CPT code 00562 covers anesthesia for procedures on the heart, pericardium, and great vessels of the chest with pump oxygenator (cardiopulmonary bypass), for non-coronary bypass procedures such as valve surgery, or for reoperation coronary bypass more than 1 month after the original operation.

The code carries 20 base units per the ASA Relative Value Guide, a mid-range value in the cardiovascular anesthesia family. 00560 carries 15 base units, while 00561 and 00563 carry 25 each.

A patient’s first-time (primary) CABG is not billed under 00562. It uses 00566 (without pump oxygenator, 25 base units) or 00567 (with pump oxygenator, 18 base units) instead.

Modifier selection (AA, QK, QX, QZ) directly affects reimbursement, and an incorrect modifier is a common denial trigger for 00562 claims.

CPT code 00562 is the anesthesia billing code for open-heart procedures performed with a pump oxygenator (cardiopulmonary bypass), in patients age 1 year or older. It covers non-coronary bypass surgery, such as valve repair, and reoperation coronary bypass performed more than one month after the original operation.

Claims for this code get denied over missing pre-anesthesia evaluation notes, incorrect modifier selection, and miscalculated time units, not undocumented procedures. The average cost to rework a single denied claim is about $25, according to MGMA data on practice revenue cycles.

This reference is built for anesthesia billers, certified coders, and practice managers handling cardiac surgery reimbursement. It separates 00562 from the neighboring 00560-00563 codes and the 00566-00567 CABG-specific codes, then pairs it with the correct diagnosis.

CPT code 00562: Clinical description and official descriptor

CPT code 00562 describes anesthesia for procedures on the heart, pericardial sac, and great vessels of the chest, with a pump oxygenator (cardiopulmonary bypass), for patients age 1 year or older.

Per the official AMA descriptor, it applies specifically to all non-coronary bypass procedures (for example, valve repair or replacement) or to reoperation for coronary bypass more than 1 month after the original operation.

It does not cover a patient’s first-time (primary) coronary artery bypass graft (CABG). That procedure has its own codes: 00566 (without pump oxygenator, 25 base units) and 00567 (with pump oxygenator, 18 base units).

This distinguishes 00562 from CPT 00560, which covers the same anatomical area without bypass, and CPT 00561, which applies to patients younger than one year. Practice managers handling cardiac surgery billing rely on practice management software to catch this distinction before claims go out, since it is the most common code-selection error in this family.

Typical procedures billed under CPT code 00562 include valve replacement or repair surgery (aortic, mitral, tricuspid), repair of the great vessels, and reoperation for coronary artery bypass performed more than one month after the original operation.

A patient’s first-time CABG is not billed under 00562. It uses 00566 or 00567 instead, based on whether a pump oxygenator was used. The pump oxygenator requirement, patient age, and the CABG-timing rule are what coders must confirm before selecting this code.

If the surgical record does not document cardiopulmonary bypass, 00560 applies instead.

Anesthesia base units for CPT code 00562

CPT code 00562 carries 20 base units per the ASA Relative Value Guide, the same source that governs base unit values across all CPT anesthesia codes.

Base units reflect the inherent complexity of the anesthesia service, independent of time. That places 00562 in the middle of the cardiovascular anesthesia family: below 00561 and 00563 (25 base units each), and above 00560 (15 base units).

How anesthesia billing is calculated

Anesthesia billing uses a unit-based formula rather than the standard RVU model. Per CMS’s Anesthesiologists Center, the payment calculation is:

Total units = base units + time units + modifying units

Reimbursement = total units x conversion factor

Time units are typically calculated in 15-minute increments, though some payers use different intervals. Confirm the time-unit interval with each payer before calculating. Modifying units reflect patient physical status (ASA PS classification) and emergency conditions.

Even with claims management software, accurate time capture is the step anesthesia billing teams most often get wrong in the formula.

The CY2026 national Medicare anesthesia conversion factor is $20.4976 per unit for most anesthesia claims, effective January 1, 2026, per the CMS Physician Fee Schedule final rule (CMS-1832-F), about a 0.88% increase over the 2025 rate of $20.3178.

CMS finalized a separate, slightly higher rate of $20.5998 for clinicians who are qualifying participants in an Advanced Alternative Payment Model. This is the anesthesia-specific conversion factor CMS publishes for anesthesiologists, not the general Physician Fee Schedule conversion factor, and it still varies further by payer contract and by locality once the geographic adjustment is applied.

Always verify the applicable conversion factor with each payer before calculating expected reimbursement.

Modifiers used with CPT 00562

Modifier selection for CPT 00562 determines both the reimbursement rate and the compliance posture of the claim.

The modifier identifies who performed the anesthesia service and in what supervisory arrangement, which CMS and commercial payers use to apply different payment percentages. Billing staff at a private practice handling HIPAA-compliant workflows should build modifier rules into their pre-submission checklists.

When QK and QX are billed together for the same case, both claims must document the medical direction arrangement. Missing documentation for the QK side is a common audit trigger. Consult a certified professional coder when the supervisory arrangement changes during the case.

Reimbursement and fee schedule 2026

Reimbursement for CPT code 00562 varies significantly by payer and geographic locality. Medicare applies the formula above using the national anesthesia conversion factor, while commercial payers negotiate separate rates.

The figures below use the 45-unit worked example from above. Always verify current rates through the CMS Physician Fee Schedule lookup tool and individual payer contracts before estimating expected payment. Practices managing multi-payer billing need software that tracks payer-specific reimbursement rules alongside claim submissions.

Locality adjustments (Geographic Practice Cost Indices) can raise or lower the Medicare rate by 10-20% depending on the service area. Verify locality-adjusted rates for your area directly through the CMS Physician Fee Schedule lookup tool or CMS’s Anesthesiologists Center, which both publish the current anesthesia conversion factors by year.

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ICD-10 codes used with open-heart surgery anesthesia

Every CPT 00562 claim requires a supporting ICD-10-CM diagnosis code that establishes medical necessity for cardiac surgery. The diagnosis must reflect the condition prompting the procedure, not the anesthesia service itself.

I25.10 pairs with 00562 specifically for a reoperation coronary bypass performed more than one month after the original operation, not a patient’s first-time CABG, which pairs with 00566 or 00567 instead. The table below covers the diagnoses most frequently paired with this code.

Diagnosis code pairing must be clinically supported by the patient’s documented condition. Do not select an ICD-10-CM code solely because it appears on a crosswalk list.

The operative report and pre-surgical notes must corroborate the primary diagnosis, whether that is I35.0 for an aortic valve procedure or another qualifying diagnosis.

Related anesthesia CPT codes

The 00560-00563 code family covers intrathoracic anesthesia for cardiac and great vessel procedures. Selecting the wrong code from this group is a common billing error, particularly when age, bypass status, or CABG timing changes between cases.

A patient’s first-time CABG needs a different family entirely: 00566 (without pump oxygenator) or 00567 (with pump oxygenator), not 00562. Practices billing a mix of cardiac procedures should review all six codes below.

Documentation requirements for billing anesthesia

Clean claims for CPT code 00562 depend on complete anesthesia records. The American Society of Anesthesiologists (ASA) and CMS both require a pre-anesthesia evaluation, an intraoperative record, and post-anesthesia documentation for all cardiac anesthesia cases.

Missing any of these gives payers grounds to deny the claim or request repayment. Structured clinical forms that capture each required field at every stage catch most of these omissions before submission.

• Pre-anesthesia evaluation: Patient history, medication review, ASA physical status classification, airway assessment, and anesthesia plan. Must be completed before the surgical procedure begins.
• Intraoperative anesthesia record: Documented start and stop times (in minutes), provider identification, drugs administered, monitoring data, and notation of pump oxygenator use and bypass start and stop times.
• Post-anesthesia care note: Patient status on arrival to PACU, vital signs, pain assessment, and discharge condition. Must be signed and timed.
• Medical necessity documentation: The operative report and pre-surgical notes must support the ICD-10-CM diagnosis code submitted with the claim, and must confirm whether a CABG is a reoperation (more than 1 month after the original operation) if 00562 is billed.
• Modifier justification: Documentation must support the modifier appended. For QK/QX, records must show the medical direction arrangement and concurrent case count.

Pabau’s compliance management tools support building anesthesia documentation templates that capture start and stop times, provider roles, and physical status classifications, reducing the manual steps between the clinical record and claim submission.

Templates built this way stay audit-ready without extra manual review before every submission.

Common billing errors and how to avoid them

These error patterns account for the majority of claim rejections in cardiac anesthesia billing.

Conclusion

Cardiac anesthesia billing gets complicated fast. CPT code 00562’s 20 base units, modifier requirements, and documentation checklist create multiple points where claims stall or get denied.

The pump oxygenator differentiator, the non-coronary or reoperation-CABG scope, correct modifier pairing, and accurate time capture are the variables that determine whether a claim pays at the correct rate, under the correct code. The same code-selection discipline carries over to cosmetic surgery practices billing anesthesia for their own surgical cases.

Pabau’s claims management software supports anesthesia billing teams with structured documentation capture, modifier tracking, and claim submission in a unified workflow. To see how it handles high-complexity surgical cases, book a demo.

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Frequently asked questions