CPT code 00142 is the designated anesthesia procedure code for lens surgery of the eye, covering anesthesia services provided during cataract extraction and refractive lens exchange (RLE). It is reported by anesthesiologists, certified registered nurse anesthetists (CRNAs), and anesthesiologist assistants (AAs) — never by the operating ophthalmologist — when a qualified anesthesia professional delivers sedation or monitored anesthesia care (MAC) in conjunction with an ophthalmic lens procedure. Understanding its correct application, payment formula, modifier requirements, and documentation standards is essential for anesthesia billing teams and revenue cycle staff managing high-volume outpatient eye surgery programs.
What Does CPT Code 00142 Mean?
CPT 00142 is defined by the AMA CPT code set as: “Anesthesia for procedures on eye; lens surgery.” Effective January 1, 2026, the short and medium descriptor language was updated, so coders should verify the current descriptor in the AMA CPT Professional Edition for the applicable date of service.
Key attributes of this code at a glance:
- Billable status: Active, separately billable by the anesthesia provider
- Applicable setting: Outpatient surgery center (ASC) or hospital outpatient department (HOPD) — the overwhelming majority of cataract procedures occur in these settings
- Provider type: Anesthesiologist (MD/DO), CRNA, or anesthesiologist assistant (AA) — not the surgeon performing the lens procedure
- Service category: Anesthesia — CPT range 00100–01999 (Head/Eye section)
- ASA base units: 4 base units (per the ASA Relative Value Guide®, as confirmed by ASA survey and applied by CMS and most commercial payers)
- Payment method: Unit-based (base units + time units × payer-specific conversion factor), not RVU-based like physician E&M codes
What Procedures Does CPT 00142 Cover?
CPT 00142 encompasses the full anesthesia service — pre-induction preparation through transfer of postoperative care — for any surgical procedure whose primary purpose is lens surgery of the eye. Clinical presentations and procedure types appropriately reported under this code include:
- Age-related cataract extraction (the most common application), including phacoemulsification with intraocular lens (IOL) implantation (CPT 66984) and complex cataract extraction with endoscopic cyclophotocoagulation (CPT 66987, 66988)
- Congenital or developmental cataract surgery in pediatric patients requiring full general anesthesia due to age or inability to cooperate
- Refractive lens exchange (RLE) performed to correct high myopia, hyperopia, or presbyopia in patients not suited for LASIK
- Secondary IOL implantation or IOL exchange procedures (CPT 66985, 66986) when a qualified anesthesia professional is involved
- Extracapsular cataract extraction (ECCE) via manual large-incision technique (CPT 66982, 66983), now less common but still performed in certain clinical scenarios
- Anesthesia provided via MAC (monitored anesthesia care) with topical, peribulbar, or retrobulbar regional technique — MAC is the predominant mode for cataract surgery in adults
What Does CPT 00142 Specifically Exclude?
- Anesthesia for non-lens eye procedures — those are reported with adjacent codes such as CPT 00140 (general eye procedures), CPT 00144 (corneal transplant), CPT 00145 (vitreoretinal surgery), CPT 00147 (iridectomy), or CPT 00148 (eye examination under anesthesia)
- The surgical procedure itself — the ophthalmologist bills the lens extraction/IOL codes (66982–66988) separately
- Routine intravenous access, cardiac monitoring, and pulse oximetry — per CMS NCCI Policy Manual Chapter 1, standard preparation and monitoring services are considered inherent to the anesthesia service and are not separately reportable
- Topical anesthetic drops or local anesthetic injections administered by the surgeon as the sole sedation method — if no qualified anesthesia professional is in personal attendance, 00142 should not be billed
When Is CPT 00142 the Right Code to Use?
In practice, billers frequently ask whether 00142 is appropriate when the involvement of an anesthesia professional is limited, or when topical anesthesia seems to be the primary technique. The code selection criteria are specific:
- Confirm a qualified anesthesia professional (anesthesiologist, CRNA, or AA) was in personal attendance throughout the procedure — not just available or on standby.
- Identify the primary surgical procedure using the ASA CROSSWALK® — the crosswalk confirms that the lens surgery CPT code (e.g., 66984) maps to anesthesia code 00142.
- Verify the anesthesia mode (general, regional nerve block, MAC, or topical with sedation) — any of these qualifies so long as a credentialed anesthesia professional provided and documented continuous care.
- Confirm the provider cannot also be billing for the surgery — per CMS Medicare Claims Processing Manual, Chapter 12, Section 50, Medicare Anesthesia Rules prevent separate anesthesia payment when the anesthesia is provided by the physician performing the surgical procedure. The operating ophthalmologist cannot bill 00142 for their own case.
- Determine the correct HCPCS modifier based on provider type and supervision level (see modifier table below) — the modifier drives payer identification of the care model and affects reimbursement.
- Apply physical status and qualifying circumstances modifiers as applicable for non-Medicare payers.
How Does CPT 00142 Differ From CPT 00140?
A common source of confusion is the distinction between 00140 and 00142, since both appear in the eye section.
| Attribute | CPT 00140 | CPT 00142 |
|---|---|---|
| Descriptor | Anesthesia for procedures on eye; NOS | Anesthesia for procedures on eye; lens surgery |
| Scope | Broad — any ophthalmic procedure not assigned a more specific code | Specific — lens (cataract/IOL/RLE) procedures only |
| ASA Base Units | 5 | 4 |
| Typical procedures | Retinal detachment repair, strabismus surgery, glaucoma filtering procedures (when 00145/00147 don’t apply) | Cataract extraction with IOL, RLE, secondary IOL |
| Selection rule | Use when no more specific ophthalmic anesthesia code applies | Use specifically when the operative CPT crosswalks to lens surgery |
Billing teams should always look up the surgical CPT code in the ASA CROSSWALK® before assigning the anesthesia code. Defaulting to 00140 when the operative report clearly documents lens surgery is a payer audit risk.
What Documentation Is Required to Support CPT 00142?
Documentation requirements for anesthesia codes differ meaningfully from E&M documentation standards. There is no MDM table or key component analysis — instead, the anesthesia record must capture the full temporal and clinical arc of the service.
What Must the Anesthesia Record Include?
The preanesthesia evaluation, intraoperative record, and postanesthesia note collectively must document:
- Preanesthesia evaluation — completed by the anesthesia professional before surgery, documenting the patient’s medical history, current medications, allergies, airway assessment, ASA physical status classification (P1–P6), and planned anesthetic technique
- Anesthesia start time — defined as the moment the anesthesia professional begins preparing the patient for induction in the procedure room, not when the chart is reviewed outside
- Anesthesia end time — the point at which the anesthesia professional is no longer in personal attendance and the patient can be safely managed under postoperative supervision
- Total anesthesia time in minutes — must be reported on the claim in minutes (not units) per CMS requirements; payers divide by 15 to calculate time units
- Mode of anesthesia (general, MAC, regional block) and specific agents administered, including topical agents if performed by the anesthesia professional
- Continuous vital sign monitoring entries throughout the case
- Intraoperative complications or changes in anesthesia plan, if any
- Postanesthesia note confirming patient status at handoff, including any recovery complications
- Supervising physician documentation if the case involves a CRNA under medical direction — the directing anesthesiologist must document their involvement per CMS medical direction rules (the seven key activities)
Facility vs. Non-Facility Documentation Considerations
Cataract surgery is almost universally performed in an ASC or HOPD, making this a facility-only service in practical billing terms. Key documentation distinctions:
ASC/HOPD (Facility) Setting:
- The facility bills separately for the procedure room, supplies, and nursing staff
- The anesthesia professional bills Part B separately using 00142 with appropriate HCPCS modifiers
- The operating facility is responsible for its own nursing/monitoring documentation; the anesthesia professional must maintain their own independent anesthesia record
- MAC procedures at ASCs require documentation that MAC was medically necessary — not simply a patient or surgeon preference — for Medicare and many commercial payers
Hospital Inpatient (Rare for cataract):
- More common for pediatric congenital cataracts requiring general anesthesia
- Documentation of general anesthesia approach, airway management, and recovery are more detailed
- The DRG payment system at the facility level absorbs the procedural component differently than ASC payment
How Does CPT 00142 Affect Medical Billing and Reimbursement?
Anesthesia billing uses a payment formula that is fundamentally different from the RVU-based system used for most physician services. This distinction trips up billers who are accustomed to E&M or surgical CPT code reimbursement structures.
The Anesthesia Payment Formula:
Payment = (Base Units + Time Units + Physical Status Units) × Conversion Factor* *Physical status units apply for most commercial payers; Medicare does not recognize physical status modifiers for payment.
For CPT 00142:
- Base Units: 4 (assigned by ASA Relative Value Guide® and adopted by CMS)
- Time Units: Total anesthesia minutes ÷ 15 (each 15-minute increment = 1 time unit)
- Conversion Factor: Varies by payer and geography; the 2022 Medicare national anesthesia conversion factor was $21.5623, while the 2022 median commercial conversion factor was reported at $78.00 (ASA Commercial Conversion Factor Survey, 2022)
Illustrative Calculation Example:
A 45-minute cataract procedure under MAC using 00142:
- Time units: 45 ÷ 15 = 3
- Total units (Medicare, no physical status): 4 + 3 = 7
- Medicare payment estimate: 7 × $21.5623 ≈ $150.94
- Commercial payment estimate (at $78.00 CF): 7 × $78.00 = $546.00
This gap illustrates why anesthesia groups closely monitor payer mix and contract negotiation for high-volume, low-base-unit procedures like cataract anesthesia.
| Component | Units | Notes |
|---|---|---|
| Base Units (CPT 00142) | 4 | ASA RVG value; adopted by CMS and most commercial payers |
| Time Units | Variable | Total anesthesia minutes ÷ 15 per CMS; some payers use 1-minute increments |
| Physical Status Units (P2) | +0 | Mild systemic disease — no additional units added for P2 under most schedules |
| Physical Status Units (P3) | +1 | Severe systemic disease — adds 1 unit for most non-Medicare payers |
| Physical Status Units (P4) | +2 | Life-threatening disease — adds 2 units for most non-Medicare payers |
| Qualifying Circumstances | Variable | QC codes (99100–99140) add units for extreme age, emergency, controlled hypotension, etc. |
| Medicare Conversion Factor (2022) | $21.5623 | CMS national rate; adjusted by geographic locality |
| Median Commercial CF (2022) | $78.00 | Per ASA Commercial Conversion Factor Survey |
What Modifiers Are Commonly Used With CPT 00142?
Modifier selection for 00142 is mandatory — it identifies who provided the anesthesia and how the service was delivered, directly impacting reimbursement rates.
| Modifier | Description | When to Apply | Payment Impact |
|---|---|---|---|
| AA | Anesthesia services personally performed by the anesthesiologist | Anesthesiologist personally provides all anesthesia care without CRNA involvement | 100% of allowed amount |
| QK | Medical direction of 2–4 concurrent anesthesia procedures by an anesthesiologist | Anesthesiologist medically directs multiple CRNAs simultaneously | 50% of allowed amount per case |
| QY | Medical direction of one CRNA by an anesthesiologist | Anesthesiologist directs a single CRNA for this case | 50% of allowed amount |
| QX | CRNA service with medical direction by a physician | CRNA performing anesthesia under physician direction | 50% of allowed amount |
| QZ | CRNA service without medical direction by a physician | CRNA providing independent anesthesia service (opt-out state or unsupervised) | 100% of CRNA allowed amount |
| AD | Medical supervision of more than 4 concurrent anesthesia procedures | Anesthesiologist supervising 5+ concurrent procedures (limited Medicare payment) | 3 base units only per case |
| QS | Monitored anesthesia care (MAC) | MAC provided for the lens procedure | Informational; no additional reimbursement |
| G8 | MAC for deep, complex, or markedly invasive procedure | MAC used because of significant procedural complexity (not routine) | Informational; no additional reimbursement |
| G9 | MAC for patient with severe cardiopulmonary condition | Patient’s medical status necessitates MAC rather than topical anesthesia alone | Informational; documents medical necessity |
| P1–P6 | ASA Physical Status Modifiers | Patient’s overall health status at time of anesthesia (P1 = healthy; P6 = brain-dead donor) | Adds units for P3+ with most commercial payers; not recognized by Medicare |
| 23 | Unusual anesthesia | General anesthesia required for a procedure usually performed under local or regional anesthesia | Additional reimbursement may apply |
Are There Any Prior Authorization, Coverage Restrictions, or LCD Requirements?
- Medicare coverage: CPT 00142 is covered under Medicare Part B for medically necessary anesthesia services. Per CMS Medicare Claims Processing Manual, Chapter 12, cataract surgery is a covered benefit; however, the anesthesia claim must be supported by a diagnosis code (ICD-10-CM) documenting a medically necessary indication (e.g., H25.11 — Age-related nuclear cataract, right eye; H26.012 — Infantile and juvenile nuclear cataract, left eye).
- MAC medical necessity documentation: Medicare and many commercial payers require documentation justifying MAC when topical anesthesia alone could have been used. Modifier G9 (severe cardiopulmonary condition) or G8 (complex procedure) strengthens the claim when MAC goes beyond the routine.
- Prior authorization: Most Medicare, Medicaid, and commercial plans do not require separate prior authorization for the anesthesia service when the surgical procedure itself has been authorized. However, some Medicare Advantage plans have imposed prior authorization requirements for outpatient cataract surgery overall — verify with each plan.
- Global period: Anesthesia CPT codes carry a global period of ZZZ, meaning they are linked to the global period of the related surgical procedure. Routine preoperative and postoperative anesthesia services are considered part of the anesthesia service and should not be billed separately.
- NCCI MUE: The Medically Unlikely Edit (MUE) for 00142 limits billing to 1 unit per eye per operative session, per day. Bilateral cataract procedures on the same day require 00142 billed twice with appropriate laterality modifiers (LT/RT) and separate anesthesia time documentation.
What CPT or HCPCS Codes Are Commonly Billed Alongside CPT 00142?
CPT 00142 is always accompanied by the surgical CPT code for the lens procedure — the two claims are submitted separately by different providers (anesthesia vs. surgeon). Additional codes may be reported in specific clinical circumstances.
| Associated Code | Description | Typical Pairing Context | Bundling Risk |
|---|---|---|---|
| 66984 | Extracapsular cataract removal w/ phacoemulsification, IOL insertion | Standard age-related cataract — most common pairing | No (separate providers) |
| 66982 | Complex cataract extraction w/ IOL, requiring devices or technique | Complicated cataracts; pediatric or traumatic cases | No (separate providers) |
| 66983 | Intracapsular cataract extraction with IOL | Less common; older technique | No (separate providers) |
| 66985 | Secondary IOL implantation | No lens present from prior surgery | No (separate providers) |
| 66987/66988 | Extracapsular cataract extraction with endoscopic cyclophotocoagulation | Combined lens + glaucoma procedure | No (separate providers) |
| 99100 | Qualifying circumstance: extreme age (under 1 or over 70) | Pediatric congenital cataracts; elderly fragile patients | Low — reported alongside 00142 |
| 99140 | Qualifying circumstance: emergency conditions | Traumatic cataract with emergency surgical need | Low — reported alongside 00142 |
| 36000 | IV placement | Routine IV access for MAC | Yes — bundled into anesthesia; do not bill separately |
| 93041/93042 | Rhythm ECG strip | Routine cardiac monitoring during anesthesia | Yes — bundled; not separately reportable |
Which Code Combinations Trigger NCCI or CCI Edits?
- 00142 billed by the same provider as 66984 (or any lens surgical code): The operating ophthalmologist cannot bill 00142 for their own case. Per the CMS NCCI Policy Manual (Chapter 3, Section C), Medicare Anesthesia Rules prevent separate anesthesia payment when furnished by the physician performing the procedure. This NCCI edit has no modifier bypass for this scenario.
- 00142 + 36000 (IV placement) by the same anesthesia provider: Standard IV access is an inherent component of anesthesia services and is not separately billable on the same date per NCCI rules.
- 00142 + 93041/93042 (ECG monitoring) by the same anesthesia provider: Routine monitoring — including cardiac, pulse oximetry, and capnography — is bundled into the anesthesia service and cannot be billed separately.
- Reporting two anesthesia codes for the same operative session: When multiple surgical procedures are performed during a single anesthesia administration, only the anesthesia code with the highest base unit value is reported; combined total time is used for time calculation.
What Coding Errors Should You Avoid With CPT 00142?
Billing teams auditing cataract anesthesia claims encounter a predictable set of recurring errors. Ranked by compliance risk and audit frequency:
- Operating surgeon billing 00142 for their own procedure — This violates Medicare Anesthesia Rules and is one of the most aggressively pursued False Claims Act risk areas in ophthalmology billing. The surgical provider and anesthesia provider must be distinct.
- Missing or incorrect HCPCS anesthesia modifier — Submitting 00142 without AA, QK, QX, QY, or QZ causes claim rejection or incorrect payment calculation. Each modifier triggers a different reimbursement rate.
- Billing anesthesia time in units rather than minutes — CMS and most commercial payers require time to be reported in actual minutes. Billing 3 units (representing 45 minutes) instead of 45 minutes prevents accurate time unit calculation.
- Using 00140 when 00142 is correct — Defaulting to the broader 00140 code for lens procedures is an AMA CPT coding violation and results in overpayment (00140 carries 5 base units vs. 00142’s 4 base units) — a payer audit and potential recoupment scenario.
- Failing to append QS modifier for MAC services — While QS is informational and doesn’t add payment, omitting it on a MAC claim can trigger medical necessity reviews and denial for lack of justification.
- Billing G8 or G9 without supporting documentation — Appending these modifiers to justify MAC without corresponding clinical documentation (cardiopulmonary history, procedure complexity notation) is a red flag during payer review.
- Reporting physical status modifiers to Medicare — Medicare does not recognize P-modifiers for payment; including them on Medicare claims is not harmful but creates noise in the claim that may require correction.
What Do Auditors and RAC Reviewers Look for When Reviewing Claims With CPT 00142?
Auditors commonly flag the following patterns during anesthesia claim reviews:
- Anesthesia time discrepancy — Anesthesia time on the claim does not match the time documented in the operative/anesthesia record
- Missing preanesthesia evaluation — No documented preoperative assessment by the directing or performing anesthesiologist prior to the procedure
- Medical direction compliance gaps — When modifier QK or QY is used, documentation must confirm the directing anesthesiologist performed all seven CMS-defined medical direction activities (patient evaluation, prescription of the anesthetic plan, personally participating in the most demanding aspects of the case, monitoring the case frequently, remaining immediately available, providing indicated post-anesthesia care, and not concurrently directing more than 4 cases)
- ICD-10-CM code mismatch — Anesthesia claim submitted with a diagnosis code that doesn’t justify lens surgery (e.g., using a refractive error code for a procedure that requires an age-related cataract code to establish medical necessity)
- Billing 00142 for procedures that crosswalk to a different anesthesia code — Submitting 00142 when the ASA CROSSWALK® points to 00140 or another code for the documented procedure
How Does CPT 00142 Relate to Other CPT Codes?
| Related Code | Relationship Type | Key Distinction |
|---|---|---|
| 00140 | Sibling (same section, more general) | Anesthesia for general eye procedures; use when surgical CPT does not crosswalk to lens-specific code |
| 00144 | Sibling (same section, different procedure) | Anesthesia for corneal transplant; do not substitute for lens surgery |
| 00145 | Sibling | Anesthesia for vitreoretinal surgery |
| 00147 | Sibling | Anesthesia for iridectomy |
| 00148 | Sibling | Anesthesia for eye examination |
| 99100 | Add-on qualifying circumstance | Extreme age — add alongside 00142 when patient is under 1 or over 70 years of age |
| 99140 | Add-on qualifying circumstance | Emergency — add alongside 00142 for emergency lens procedures |
| 66984 | Surgical counterpart (billed by surgeon) | The most commonly paired surgical code; triggers 00142 via ASA CROSSWALK® |
| 64400–64489 | Peripheral nerve block codes | Separately reportable only when provided by anesthesia professional independent of the anesthesia service |
What Is the Correct Code Sequencing or Reporting Order When CPT 00142 Appears With Other Codes?
- Lead with the primary anesthesia code 00142 on the anesthesia claim.
- Append required HCPCS modifier (AA, QK, QX, QY, QZ) as the first modifier.
- Add QS, G8, or G9 if MAC is the modality — place after the provider-type modifier.
- Append physical status modifier (P1–P6) after provider and MAC modifiers — for non-Medicare payers only.
- Report qualifying circumstance codes (99100, 99140) on a separate line item on the same claim, not as a modifier.
- Do not report the surgical CPT code on the anesthesia claim. The anesthesia professional submits only the anesthesia code; the surgeon submits the surgical code on a separate claim.
Real-World Coding Scenario — How CPT 00142 Is Applied in Practice
Clinical Encounter: A 74-year-old patient with hypertension (controlled) and type 2 diabetes presents for outpatient phacoemulsification cataract extraction with IOL implantation of the right eye at an ambulatory surgery center. The procedure is performed by an ophthalmologist. A CRNA from an independent anesthesia group provides MAC with IV sedation (propofol and fentanyl) under the medical direction of an anesthesiologist who is simultaneously medically directing two other cases. Total anesthesia time documented in the record: 38 minutes. The patient’s ASA physical status is classified as P2.
Correct Code Application
- Anesthesia provider bills: CPT 00142, Modifier QX (CRNA under medical direction), Modifier QS (MAC), Modifier P2
- Directing anesthesiologist bills: CPT 00142, Modifier QK (medical direction of 2–4 concurrent procedures), Modifier QS, Modifier P2
- Time units: 38 ÷ 15 = 2.53 → round per payer convention (many use 2.5; Medicare rounds to nearest unit in some MACs)
- Total units (Medicare, no P-modifier effect): 4 base + 2.5 time = 6.5 units
- Diagnosis code linked: H25.011 (Cortical age-related cataract, right eye) or H25.811 (Combined forms of age-related cataract, right eye) — confirm to operative report and ICD-10-CM tabular
- Payment split: Medicare pays each provider 50% of the allowed amount under the QK/QX model
Common Mistake in This Scenario
- Incorrect: Billing CPT 00140 instead of 00142 because the coder confused “general eye procedures” with “lens surgery”
- This overcodes by 1 base unit (5 vs. 4), results in a higher-than-allowed payment, and will trigger payer recoupment if identified on audit
- Incorrect: The anesthesiologist directing the case bills modifier AA instead of QK
- AA indicates personal performance of all anesthesia care; the CRNA is performing the case, not the anesthesiologist. Using AA when QK/QX is appropriate is a False Claims Act risk
- Incorrect: CRNA bills QZ (independent, no direction)
- The clinical scenario documents active medical direction by the anesthesiologist; QZ misrepresents the care model and could constitute upcoding
Frequently Asked Questions About CPT Code 00142
Is CPT Code 00142 Still Valid for Use in 2026?
CPT code 00142 remains a valid, active code for 2026; however, its short and medium descriptor language was updated effective January 1, 2026. Coders and billers should verify the current descriptor against the 2026 AMA CPT Professional Edition and confirm that their practice management system has loaded the updated code description to avoid claims-editing failures.
How Many Base Units Does CPT 00142 Carry?
CPT 00142 carries 4 base units as assigned in the ASA Relative Value Guide® (RVG®). This value was confirmed through formal anesthesiologist survey and adopted by CMS, reflecting that cataract surgery under MAC — which describes more than 50% of the procedure volume — involves comparatively less anesthesia work intensity than general anesthesia procedures.
Can a CRNA Bill CPT 00142 Without Physician Supervision?
Yes, a CRNA may bill CPT 00142 independently by appending modifier QZ (CRNA service without medical direction by a physician). This applies in states that have opted out of the Medicare physician supervision requirement for CRNAs, or when the clinical circumstances genuinely do not involve physician direction. The CRNA receives 100% of the anesthesia allowed amount under this modifier rather than the 50% split applicable in directed care models.
What Is the Difference Between Billing 00142 With QS Versus G9?
Modifier QS designates that the anesthesia service was delivered as monitored anesthesia care; it is informational and does not add reimbursement. Modifier G9 is used to document that MAC was medically necessary because of the patient’s severe cardiopulmonary condition — this modifier justifies the use of MAC when topical anesthesia alone might otherwise be considered sufficient, which is important for supporting medical necessity documentation in payer reviews, particularly for Medicare Advantage plans with aggressive prior authorization policies.
Can the Ophthalmologist Performing Cataract Surgery Also Bill CPT 00142?
No. CMS Medicare Anesthesia Rules explicitly prohibit the physician performing a medical or surgical procedure from separately billing anesthesia for that same procedure. The operating ophthalmologist cannot bill 00142 for their own cataract extraction — a separate, qualified anesthesia professional must provide and independently document the anesthesia service for 00142 to be appropriately submitted.
What ICD-10-CM Diagnosis Codes Support CPT 00142 Claims?
The diagnosis code on the anesthesia claim should reflect the condition that necessitated the lens surgery, mirroring the ICD-10-CM code submitted by the operating surgeon. Commonly linked codes include: H25.011–H25.819 (age-related cataract, various types and laterality), H26.001–H26.499 (other and unspecified cataracts), H27.01–H27.12 (aphakia, dislocation of lens), and Q12.0 (congenital cataract) for pediatric cases. Payers use the ICD-10 code to confirm that the anesthesia service aligns with a medically covered surgical indication.
Key Takeaways for Billing and Coding CPT 00142
- CPT 00142 reports anesthesia for lens surgery (cataract extraction, RLE, IOL procedures) — always verify the surgical CPT crosswalks to this code using the ASA CROSSWALK® before billing
- The code carries 4 ASA base units — using 00140 (5 base units) for lens surgery is an overcoding error with recoupment risk
- Payment is calculated using the anesthesia formula: (Base Units + Time Units) × Conversion Factor — anesthesia time must be reported in minutes, not pre-calculated units
- A correct HCPCS provider-type modifier (AA, QK, QX, QY, QZ) is mandatory on every claim and directly determines the reimbursement rate
- The operating ophthalmologist cannot bill 00142 for their own lens procedure — this is an absolute NCCI/Medicare Anesthesia Rules prohibition
- For MAC cases, append modifier QS (and G9 when the patient’s cardiopulmonary status justifies MAC) to support medical necessity documentation
- Physical status modifiers P1–P6 are additive for most commercial payers but are not recognized by Medicare for payment purposes
- Standard anesthesia preparation, monitoring, and IV access are bundled into 00142 and must never be billed separately on the same claim
For RVU and reimbursement rates by locality, consult the CMS Physician Fee Schedule lookup tool and the CMS Medicare Claims Processing Manual, Chapter 12, Section 50 for complete anesthesia billing rules. For anesthesia base unit values and crosswalk methodology, reference the ASA Relative Value Guide® (RVG®) and the CMS NCCI Policy Manual for bundling edit guidance.
