CPT code 00926: Anesthesia for male genitalia procedures

Key takeaways

CPT code 00926 covers anesthesia for male genitalia procedures, specifically radical orchiectomy (inguinal) and open urethral procedures.

The code carries 4 anesthesia base units, and payment follows the formula (base units + time units) x conversion factor.

Because 00920 carries 3 base units, choosing it instead of 00926 understates the claim by one unit, or about $20 at 2026 Medicare rates.

Missing modifiers, mismatched ICD-10 codes, and imprecise start and stop times cause most 00926 denials and underpayments.

Practice management software like Pabau helps anesthesia teams document physical status, validate modifiers, and submit cleaner 00926 claims.

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’s conversion factor.

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.

CPT code 00926: definition and procedure description

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.

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.

The American Medical Association (AMA) maintains the CPT code set, including the 00920 series. Code descriptions are updated annually; always verify against the current year’s AMA CPT manual before using 00926 on a claim.

Anesthesia base units and reimbursement formula

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.

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.

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, from 00580 to 01620.

Formula: (base units + time units + QCF) x conversion factor = reimbursement

Worked example: 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.

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.

Time unit calculation and reporting

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.

Time carries most of the payment on a 00926 claim. A 90-minute case generates 6 time units against the code’s 4 base units, so time accounts for well over half the total.

Figures use the 2026 national anesthesia conversion factor of $20.4976 and no geographic adjustment. Your locality rate will differ.

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.

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.

Medicare reimbursement rates for 00926 in 2026

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 Physician Fee Schedule. 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%.

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.

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.

Modifiers on a 00926 claim

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.

Physical status modifiers (P1-P6)

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.

Medicare does not recognize physical status unit additions for P3-P5. Many commercial payers do recognize them. Confirm each payer’s policy before including those additional units in your claim calculation. Underbilling because you assumed a payer follows Medicare’s physical status rules costs revenue. Overbilling triggers compliance risk.

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.

Qualifying circumstances that add units

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.

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.

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.

ICD-10 codes commonly billed with 00926

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.

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’s documentation.

The AAPC Codify 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.

Related anesthesia codes in the 00920 series

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.

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’s descriptor, so 00920 understates the service by one base unit.

At the 2026 Medicare conversion factor that is roughly $20 per case, or about $2,000 across 100 cases.

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.

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.

Documentation requirements and common denial reasons

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.

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.

• Anesthesia start time and stop time (exact, to the minute)
• Patient physical status classification (P1-P6) documented by the anesthesia provider
• Identity and credentials of the anesthesia provider (anesthesiologist, CRNA, or both)
• Supervision arrangement clearly documented (if billing QK/QX or QY)
• The specific surgical procedure performed (radical orchiectomy inguinal or open urethral procedure)
• ICD-10 diagnosis code supported by physician documentation in the same episode
• Signed attestation from the anesthesia provider confirming service delivery

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, so check your state’s medical record retention rules and keep the files retrievable.

The most common denial reasons for 00926 claims break into four categories.

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, so billing teams in surgical practices need separate training on them.

How Pabau supports anesthesia billing workflows

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.

Practice management software like Pabau keeps those steps in one record. Its claims management software supports structured claim preparation for procedure-based specialties, including anesthesia. Four things matter most for practices billing 00926 regularly.

• Structured documentation capture: Digital forms can require anesthesia start time, stop time, and physical status before the record closes. Incomplete documentation never reaches the billing queue.
• Modifier validation: Claim rules can be configured to flag claims where the anesthesia modifier is absent or inconsistent with the documented provider role.
• ICD-10 code mapping: 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.
• Audit trail: Every edit to a claim record is timestamped and attributed, giving practices a defensible audit trail if a payer requests supporting documentation post-payment.

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.

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.

Submit cleaner anesthesia claims first time

Pabau'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.

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Conclusion

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.

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.

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. Book a demo to see how Pabau handles anesthesia billing.

Continue your research

Coding an orchiopexy instead? CPT 00930 sets out the anesthesia code for unilateral and bilateral orchiopexy, with its base units and modifiers.

Working across the wider perineum family? CPT 00902 explains how anesthesia for perineum procedures is coded, documented, and paid.

Need the surgical side of a testicular emergency? CPT 54600 covers reduction of testicular torsion, from operative documentation through to reimbursement.

Billing the imaging that comes before surgery? CPT 76870 covers scrotal ultrasound, including the diagnoses that support medical necessity.

Documenting the exam behind the diagnosis? Cremasteric reflex explains how to elicit the reflex and what an absent response means.

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