Summary & Overview
CPT 33400: Open Aortic Valve Replacement with Cardiopulmonary Bypass
Headline: CPT 33400: Open Aortic Valve Replacement with Cardiopulmonary Bypass
Lead: CPT 33400 denotes open surgical replacement of the aortic valve performed with cardiopulmonary bypass, a high-acuity cardiothoracic procedure that remains a cornerstone treatment for severe aortic valve disease. It is typically performed in the inpatient hospital setting and has broad implications for surgical practice, hospital resource use, and payer coverage.
CPT 33400 represents definitive surgical management for aortic valve pathology when valve repair or less invasive options are not appropriate. Nationally, this code is significant because it captures a resource-intensive procedure associated with substantial perioperative care, operating room time, and postoperative inpatient recovery. The analysis covers major commercial payers and their approaches to coverage and reimbursement for surgical valve replacement.
Key payers included in this review are Blue Cross Blue Shield and Cigna Health. Readers will find an overview of clinical context, coding and billing considerations, commonly associated procedure and diagnosis groupings, and related CPT codes that are frequently documented in the perioperative course. The publication outlines operational and coding touchpoints relevant to hospitals and cardiothoracic surgeons, and it highlights where additional local payer policy review may be needed.
This summary provides a concise reference for clinicians, coding professionals, and hospital administrators seeking a national-level understanding of CPT 33400 and its role in contemporary cardiac surgical care.
CPT Code Overview
CPT 33400 describes replacement of the aortic valve via an open approach performed with cardiopulmonary bypass. This procedure is a cardiothoracic surgical intervention that involves removing a diseased aortic valve and implanting a replacement prosthetic valve while the patient is supported by cardiopulmonary bypass.
Service Type: Cardiothoracic Surgery
Typical Site of Service: Inpatient Hospital (POS 21)
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient presents with symptomatic aortic valve disease (exertional dyspnea, angina, or syncope) and echocardiographic confirmation of severe aortic stenosis or mixed aortic stenosis/insufficiency. Preoperative evaluation includes cardiac catheterization to assess coronary anatomy, transthoracic or transesophageal echocardiography for valve morphology and function, and multidisciplinary review by cardiothoracic surgery and cardiovascular medicine. The patient is admitted to the inpatient hospital (POS 21) for preoperative optimization, undergoes general endotracheal anesthesia, median sternotomy, cardiopulmonary bypass, excision of the native aortic valve, and placement of a prosthetic aortic valve. Postoperative care includes intensive care unit monitoring, hemodynamic support, rhythm surveillance, and discharge planning with follow-up.
Coding Specifications
-
Modifiers
-
22: Increased Procedural Services — Use when the work, time, technical difficulty, or risk of the procedure is substantially greater than typically required for33400; documentation must support the reason for increased services. -
63: Procedure performed on infants less than 4 kg — Use when33400is performed on an infant weighing under 4 kilograms; documentation must state the infant's weight. -
Provider Taxonomies
| Taxonomy Code | Specialty Name | Clinical Representation |
|---|---|---|
208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Cardiothoracic surgeons who perform open heart valve surgery |
208600000X | Surgery Physician | Surgeons providing operative care, including valve replacement |
207RC0000X | Cardiovascular Disease Physician | Cardiologists involved in diagnosis, preoperative assessment, and postoperative management |
Related Diagnoses
-
I35.0— Nonrheumatic aortic (valve) stenosisClinical relevance: Severe stenosis creates outflow obstruction prompting aortic valve replacement such as
33400to relieve symptoms and improve hemodynamics. -
I35.1— Nonrheumatic aortic (valve) insufficiencyClinical relevance: Significant regurgitation causing volume overload and symptoms can indicate surgical valve replacement with
33400. -
I35.2— Nonrheumatic aortic (valve) stenosis with insufficiencyClinical relevance: Mixed disease with both obstruction and regurgitation frequently requires definitive surgical replacement via
33400. -
I06.0— Rheumatic aortic stenosisClinical relevance: Rheumatic involvement of the aortic valve leading to stenosis may be treated with open replacement such as
33400when repair is not feasible. -
I06.2— Rheumatic aortic stenosis with insufficiencyClinical relevance: Combined rheumatic stenosis and regurgitation often necessitates valve replacement with procedures coded by
33400.
Related CPT Codes
| CPT Code | Description | Relationship to 33400 |
|---|---|---|
33405 | Replacement, aortic valve, with prosthesis, open, with cardiopulmonary bypass | Alternative or specific descriptor when identifying use of a prosthetic valve; clinically related as a closely associated valve replacement code |
33533 | Coronary artery bypass, using arterial graft(s); single arterial graft | Commonly performed during the same operative session when significant coronary disease is identified on preoperative catheterization; may be billed in conjunction when both procedures are performed |
92986 | Percutaneous balloon valvuloplasty; aortic valve | Less invasive alternative to open replacement in select patients; may be considered prior to or instead of 33400 depending on clinical indications |
33210 | Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter | May be used intraoperatively or postoperatively for temporary pacing support during recovery from 33400; often performed in the same perioperative episode |
National Reimbursement Benchmarks
National mean commercial rates for CPT 33400 are higher than Medicare averages where available: BUCA (average commercial) has a mean of $4,692.27 compared with Medicare data not provided in the input. Blue Cross Blue Shield (BCBS) reports a mean of $4,155.69, and Cigna reports a mean of $4,869.62.
Rate dispersion (P75 minus P25) shows that Cigna and BUCA have wider spreads: Cigna’s dispersion is $2,284.00 ( $6,172.50 − $3,888.50 ) and BUCA’s dispersion is $2,692.50 ( $6,113.00 − $3,420.50 ), while BCBS is narrower with a dispersion of $2,986.00 ( $5,998.00 − $3,012.00 ). The table and chart below present the full breakdown.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.