CPT code 00322 reports the anesthesia service furnished during a needle biopsy of the thyroid gland. It sits inside the 00300–00352 neck-anesthesia family, which covers anesthesia for all procedures on the esophagus, thyroid, larynx, trachea, and lymphatic system of the neck. Because 00322 is an anesthesia code, not a surgical code, it is billed by the anesthesiologist or CRNA managing sedation — never by the physician performing the biopsy itself, who reports a separate surgical or radiology code.

What Does CPT Code 00322 Mean?

CPT 00322 is the AMA’s designated anesthesia code for a needle biopsy of the thyroid, whether performed as a fine needle aspiration biopsy (FNAB) or a percutaneous core needle biopsy. It carries 3 base units under the CMS anesthesia base unit table, reflecting the low physiologic risk and short duration typical of this procedure.

• Billable status: Yes, separately billable when medically necessary anesthesia (monitored anesthesia care, general anesthesia, or deep sedation) is documented
• Applicable setting: Outpatient clinic, ambulatory surgery center, hospital outpatient, or interventional radiology suite
• Provider type: Anesthesiologist, CRNA, or anesthesiologist assistant under medical direction
• Service category: Anesthesia (00000–01999 range), not surgery, radiology, or E&M
• Base units: 3, per CMS and VA Community Care anesthesia base unit tables

What Services and Procedures Does CPT 00322 Cover?

CPT 00322 covers the anesthesia management component only — airway assessment, sedation or general anesthesia administration, hemodynamic monitoring, and recovery oversight for a patient undergoing a needle biopsy of the thyroid. The code applies regardless of whether the proceduralist uses:

• Ultrasound-guided fine needle aspiration (reported separately by the proceduralist as 10021 or 10022)
• Percutaneous core needle biopsy (reported separately as 60100)
• Either technique performed in a clinic, ASC, or hospital outpatient department

What Does CPT 00322 Specifically Exclude?

• Open thyroid procedures such as thyroidectomy or thyroid lobectomy — these fall under 00320 (the broader neck anesthesia code for open esophagus, thyroid, larynx, trachea, and lymphatic procedures)
• The biopsy procedure itself — CPT 00322 and the surgical/radiology biopsy code are two separate line items and are never bundled into one claim
• Imaging guidance codes (e.g., 76942 ultrasound guidance) — these are reported by the proceduralist, not the anesthesia provider
• Local anesthesia administered by the proceduralist alone, with no separate anesthesia provider involved — in that scenario, 00322 is typically not separately billable

When Is CPT 00322 the Right Code to Use?

1. Confirm a dedicated anesthesia provider (anesthesiologist or CRNA) is furnishing and documenting the anesthetic — not just local infiltration by the proceduralist
2. Confirm the approach is percutaneous needle biopsy, not an open surgical incision
3. Confirm the target structure is the thyroid gland, not the larynx, trachea, esophagus, or cervical lymph nodes (which map to different codes within the same family)
4. Verify the anesthesia record documents start and stop times to support time-unit billing
5. Cross-check that the proceduralist’s operative note supports the surgical/radiology code (10021, 10022, or 60100) that will accompany the anesthesia claim

How Does CPT 00322 Differ From CPT 00320?

Attribute	CPT 00322	CPT 00320
Procedure type	Needle biopsy of thyroid	Broader “not otherwise specified” neck procedures, including open thyroidectomy
Base units	3	6
Approach	Percutaneous	Often open/surgical
Typical setting	Clinic, ASC, IR suite	Operating room
Patient age scope	All ages	Age 1 year and older

What Documentation Is Required to Support CPT 00322?

Anesthesia claims are audited on time, base units, and medical necessity — not on the medical decision-making elements used for E&M codes. In practice, auditors reviewing anesthesia claims for needle procedures frequently flag missing start/stop times or a mismatch between the anesthesia record and the proceduralist’s op note, so documentation precision matters even for a short case like this one.

What Must the Provider Document in the Anesthesia Record?

1. Preoperative assessment and ASA physical status classification
2. Anesthetic technique used (MAC, general anesthesia, or deep sedation)
3. Anesthesia start time and stop time, to the minute
4. Any qualifying circumstances (e.g., extreme age, emergency conditions) if applicable
5. Recovery/discharge documentation confirming the patient met discharge criteria

How Are Base Units and Time Units Documented for CPT 00322?

• Base units are fixed at 3 for 00322 and require no separate calculation
• Time units are calculated from the anesthesia start time to the anesthesia stop time, generally in 15-minute increments per payer policy
• Qualifying circumstance codes (e.g., 99100, 99116, 99135, 99140) are added as separate line items only when the clinical scenario applies and is documented
• Billing teams in multi-specialty practices commonly ask whether monitoring performed by the proceduralist alone (without a dedicated anesthesia provider) qualifies for 00322 — it generally does not, since the code represents a distinct anesthesia service line

What Are the Documentation Standards for Facility vs. Non-Facility Settings?

Setting	Documentation emphasis
Non-facility (office/clinic)	Anesthesia provider’s own record must independently support time and medical necessity, since facility charting may be minimal
Facility (ASC/hospital outpatient)	Anesthesia record is cross-referenced against facility nursing and recovery-room documentation for consistency

How Does CPT 00322 Affect Medical Billing and Reimbursement?

Anesthesia reimbursement is not calculated from a flat relative value like an E&M code — it’s a base units + time units + qualifying circumstance units, multiplied by the anesthesia conversion factor formula.

Component	Value for CPT 00322
Base units	3
Time units	Variable — 1 unit per 15 minutes (payer-dependent)
Qualifying circumstance units	Added only if applicable
2026 Medicare anesthesia conversion factor (non-QP)	$20.4976
Illustrative payment (3 base units + 2 time units, no QP)	(3 + 2) x $20.4976 — $102.49

Payer considerations:

• Anesthesia payments follow the Medicare Claims Processing Manual, Chapter 12, Section 50
• Commercial payers frequently use their own anesthesia conversion factor rather than the Medicare rate, so verify the payer fee schedule before estimating reimbursement
• Medical necessity must tie back to the reason a dedicated anesthesia provider — rather than local anesthesia by the proceduralist — was required (e.g., anxiety, difficult anatomy, pediatric patient, or bleeding risk)

What Modifiers Are Commonly Used With CPT 00322?

Modifier	Description	When to Apply	Billing Impact
AA	Anesthesia performed personally by anesthesiologist	Anesthesiologist provides the entire service alone	Full payment
QK	Medical direction of 2–4 concurrent procedures	Anesthesiologist medically directs CRNAs	Split payment (typically 50% each)
QX	CRNA service with medical direction by physician	CRNA under medical direction	Split payment
QZ	CRNA service without medical direction	CRNA acting independently	Full CRNA payment
P1–P6	ASA physical status modifiers	Always required to reflect patient risk level	May affect payer-specific add-on payment

Are There Prior Authorization, Coverage Restrictions, or LCD Requirements?

• Some payers apply an LCD/medical necessity policy requiring documentation of why monitored anesthesia care was clinically indicated for a needle biopsy
• Prior authorization is uncommon for the anesthesia component itself, but the underlying biopsy procedure may require it depending on the payer
• NCCI bundling edits should be checked before submission, since anesthesia codes can be subject to Correct Coding Initiative pairs with certain monitoring or injection codes billed on the same date

What CPT or HCPCS Codes Are Commonly Billed Alongside CPT 00322?

Associated Code	Description	Typical Pairing Context	Bundling Risk
10021	Fine needle aspiration, without imaging guidance	Proceduralist’s biopsy code	No (separate provider/claim)
10022	Fine needle aspiration, with imaging guidance	Proceduralist’s biopsy code	No
60100	Biopsy thyroid, percutaneous core needle	Proceduralist’s biopsy code	No
76942	Ultrasound guidance for needle placement	Imaging guidance for the biopsy	No, but check MUE limits
99100/99116/99135/99140	Anesthesia qualifying circumstance add-ons	Extreme age, hypotension, field avoidance, emergency	Yes, only allowed when clinically documented

Which Code Combinations Trigger NCCI or CCI Edits?

• Review current NCCI edits before pairing 00322 with any concurrent monitoring or moderate sedation code billed by the same provider on the same date
• Confirm the proceduralist and anesthesia provider are billing separate, non-overlapping components — duplicate billing of monitoring services is a common denial trigger
• If imaging guidance (76942) is billed once per session per current MUE guidance, verify it isn’t billed multiple times for biopsies of multiple nodules in the same encounter

What Coding Errors Should You Avoid With CPT 00322?

1. Billing 00322 for an open thyroid procedure — that belongs under 00320, not 00322
2. Failing to document anesthesia start and stop times, which are required to calculate time units
3. Submitting 00322 when only local anesthesia by the proceduralist was used, with no distinct anesthesia provider involved
4. Omitting the ASA physical status modifier, which most payers require on every anesthesia claim
5. Mismatching the anesthesia diagnosis code with the proceduralist’s biopsy diagnosis, creating a medical necessity discrepancy

What Do Auditors Look for When Reviewing Claims With CPT 00322?

• Anesthesia records lacking a clear medical necessity rationale for monitored anesthesia care during a routine needle biopsy
• Time documentation that doesn’t align between the anesthesia record and the facility’s procedure log
• Qualifying circumstance codes billed without supporting documentation in the anesthesia note
• Modifier combinations (e.g., QK with AA) that are internally inconsistent with the documented level of medical direction

How Does CPT 00322 Relate to Other CPT Codes?

Related Code	Relationship Type	Key Distinction
00320	Sibling code, same family	Broader/open neck procedures vs. 00322’s needle biopsy scope
00300	Sibling code, same family	Integumentary/muscle/nerve procedures of head, neck, posterior trunk
60100	Paired surgical code	Reports the biopsy itself; billed by a different provider on a separate claim
10021/10022	Paired surgical code	Reports FNA biopsy; billed by a different provider on a separate claim
99100–99140	Add-on qualifying circumstance codes	Reported alongside 00322 only when the clinical scenario applies

What Is the Correct Sequencing When CPT 00322 Appears With Other Codes?

1. Report the anesthesia code (00322) as the primary line on the anesthesia claim
2. Append required modifiers (AA, QK, QX, or QZ) plus the ASA physical status modifier
3. Add qualifying circumstance codes as separate line items only when documentation supports them
4. Ensure the proceduralist’s claim (10021, 10022, or 60100) is submitted independently, referencing the matching diagnosis code

Real-World Coding Scenario — How CPT 00322 Is Applied in Practice

A 52-year-old patient with a history of anxiety and a difficult airway is scheduled for an ultrasound-guided fine needle aspiration of a thyroid nodule. Given the airway history, the endocrinologist requests a dedicated anesthesia provider for monitored anesthesia care rather than local anesthesia alone. The CRNA documents a full preoperative assessment, ASA physical status III, anesthesia start and stop times, and continuous monitoring throughout the 25-minute procedure.

Correct Code Application

• CPT 00322 billed by the CRNA with modifier QZ (no medical direction) and physical status modifier P3
• CPT 10022 billed separately by the endocrinologist for the FNA with imaging guidance
• Anesthesia claim reflects 3 base units + 2 time units, supported by documented start/stop times

Common Mistake in This Scenario

• Billing 00322 with modifier AA when the CRNA actually worked without physician medical direction — this modifier mismatch is a frequent cause of claim denial or post-payment audit findings

Frequently Asked Questions About CPT Code 00322

Is CPT Code 00322 Still Valid for Use in 2026?

CPT code 00322 remains an active, billable anesthesia code for 2026 with no changes to its descriptor under the AMA CPT code set. Coders should still confirm annually against the AMA CPT Professional Edition and the CMS Physician Fee Schedule to verify base units and conversion factor updates haven’t shifted the payment calculation.

What Is the Difference Between CPT 00322 and CPT 00320?

CPT 00322 applies specifically to a needle biopsy of the thyroid and carries 3 base units, while CPT 00320 is the broader neck anesthesia code covering open procedures such as thyroidectomy and carries 6 base units. The key differentiator is surgical approach — percutaneous needle biopsy versus open surgical access — not the anatomic structure involved.

How Is CPT 00322 Reimbursed Under Medicare?

Medicare reimburses CPT 00322 using the anesthesia formula of base units plus time units plus any qualifying circumstance units, multiplied by the current anesthesia conversion factor. For 2026, the non-qualifying-APM anesthesia conversion factor is $20.4976, so a typical short case with 3 base units and 2 time units would reimburse at roughly $102 before locality adjustments.

What Documentation Is Required to Bill CPT 00322?

Anesthesia claims for CPT 00322 require a documented ASA physical status, anesthesia start and stop times, the anesthetic technique used, and a clear medical necessity rationale for involving a dedicated anesthesia provider. Missing start/stop times are one of the most common reasons anesthesia claims for short procedures get denied or downcoded.

What Modifiers Are Required When Billing CPT 00322?

Every CPT 00322 claim should include a provider-role modifier (AA, QK, QX, or QZ) reflecting who performed or directed the anesthesia, along with an ASA physical status modifier (P1–P6). Mismatched provider-role modifiers, such as billing AA when a CRNA worked without medical direction, are a leading cause of claim denials.

What Coding Mistakes Most Often Trigger Audits for CPT 00322?

The most common audit triggers are billing 00322 for an open thyroid procedure that should be 00320, missing time documentation, and submitting qualifying circumstance add-on codes without supporting clinical documentation. Auditors also frequently check that the anesthesia diagnosis aligns with the proceduralist’s biopsy diagnosis.

Key Takeaways for Billing and Coding CPT 00322

• CPT 00322 reports anesthesia for a needle biopsy of the thyroid — it never represents the biopsy procedure itself
• It carries 3 base units, distinguishing it from the 6-base-unit code 00320 used for open neck/thyroid procedures
• Reimbursement depends on base units + time units + qualifying circumstances, multiplied by the anesthesia conversion factor, not a flat fee
• Provider-role modifiers (AA, QK, QX, QZ) plus an ASA physical status modifier are required on essentially every claim
• The proceduralist’s biopsy code (10021, 10022, or 60100) is always billed separately from the anesthesia code
• Missing anesthesia start/stop times and modifier mismatches are the two most frequent causes of denials and audit findings
• Confirm current-year RVU, conversion factor, and NCCI bundling edits through the CMS Physician Fee Schedule lookup tool before finalizing claims, since these values update annually

For deeper guidance on medical billing documentation requirements, CPT coding guidelines, and coding audit preparation, verify current values directly against the CMS Physician Fee Schedule (PFS) lookup tool, the AMA CPT code set reference, the CMS National Correct Coding Initiative (NCCI) guidelines, and the Medicare Claims Processing Manual, Chapter 12 before submitting claims involving this code.