CPT 00904
Priced using anesthesia methodology
00904 · PFS Q2 2013 · Historical
Illustrative example
~$240.02
Formula (base_units + time_units) × anesthesia_cf Localis calculated this from CMS’s published inputs. Select an underlined value to see where it comes from. time_units = time_minutes / 15, rounded to one decimal place. The anesthesia conversion factor is CMS's published locality-adjusted value. Citations Supplies the RVUs and PFS status for this code and component. Q2 2013 · revision 1 Latest revision of this release Release period: April 1 – June 30, 2013 SHA-256: 7fa3270fb0a8148879b2996a1887928fbf73b8e70349c1dbd21d890154392e54 Supplies the geographic adjustment factors for this locality. Q2 2013 · revision 1 Latest revision of this release Release period: April 1 – June 30, 2013 SHA-256: 445bfe306db4fa6abc834ff7015d2afb42353e7c8f369486671c173818e5b680 Supplies the dollar conversion factor used in the formula. Q2 2013 · revision 1 Latest revision of this release Release period: April 1 – June 30, 2013 SHA-256: 7fa3270fb0a8148879b2996a1887928fbf73b8e70349c1dbd21d890154392e54 Q2 2013 · revision 1 Latest revision of this release Release period: April 1 – June 30, 2013 SHA-256: ec437ff66b1b880ffc38cad2e3b716fe3ce28489148bddc7aa17b50fec2533bc
Source
Record details
PPRRVU13.V0215_04162013.csv
in
rvu13b.zip
(row 4,071)
Record details
GPCI2013.csv
in
rvu13b.zip
(row 77)
Record details
PPRRVU13.V0215_04162013.csv
in
rvu13b.zip
(row 11)
Record details
ANES2013.csv
in
rvu13b.zip
(row 78)
60-minute example case in Dallas, TX
Anesthesia has no single national rate—payment is (base units + time units) × the locality's anesthesia conversion factor. This example is before sequestration. Enter the service-location ZIP and case length for a local estimate.
Base units 7—set by CMS for this code and the same in every locality. One time unit is 15 minutes, rounded to one decimal, so a 60-minute case adds 4 time units.
CPT 00904 is an anesthesia code, so Medicare has no single national rate: payment is (base units + time units) × the locality's anesthesia conversion factor—for example, about $240.02 for a 60-minute case in Dallas, TX under the Q2 2013 release, before sequestration.
Amount evidence: base units, time units, and the locality conversion factor, shown in the estimate. The PFS row shows this code is priced as anesthesia.
Inspect PFS status evidence
- Code
- 00904
- Release
- Q2 2013, revision 1
- Result
- Priced using anesthesia methodology
Citations
-
Shows this code’s PFS status (J). Result: Priced using anesthesia methodology.
Physician relative value file (PPRRVU)Q2 2013 · revision 1
Latest revision of this release
Release period: April 1 – June 30, 2013
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
Record details
PPRRVU13.V0215_04162013.csv in rvu13b.zip (row 4,071)- hcpcs (col 1)
- 00904
- modifier (col 2)
- blank
- status_code (col 4)
- J
SHA-256: 7fa3270fb0a8148879b2996a1887928fbf73b8e70349c1dbd21d890154392e54
Why is there no national PFS amount for 00904?
Its status indicator is J (anesthesia). Medicare prices this under the anesthesia formula—(base units + time units) × the locality anesthesia conversion factor—not the standard RVU formula. Choose a locality to see that factor.
Payment considerations Copy link
Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.
Other payment indicators (10)
Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
Can you bill it with another code? Copy link
Check a pair of codes Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.
How has it changed? Copy link
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Usage and related codes Copy link
How often 00904 is billed Copy link
Across Original Medicare in CY2024, 00904 ranked #3,093 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 1.7 times on average that year.
2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q2 2013 fee schedule above.
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Source & method
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The anesthesia estimate uses the base units, case length, and locality conversion factor shown beside it. The PFS file shows this code is priced as anesthesia. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
The citation names the release, so anyone can check it even after CMS publishes a newer one.
CPT 00904 National PFS baseline: No national PFS rate (Q2 2013; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/00904/2013/B