Summary & Overview
CPT 33426: Mitral Valve Valvuloplasty with Cardiopulmonary Bypass
CPT code 33426 represents a critical surgical procedure: valvuloplasty of the mitral valve with cardiopulmonary bypass. This operation is essential for patients with mitral valve disease, including stenosis and insufficiency, and is performed in an inpatient hospital setting. The code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, underscoring its clinical and reimbursement significance.
This publication provides a comprehensive overview of 33426, covering payer coverage, clinical context, and related coding benchmarks. Readers will gain insight into the procedure's role in cardiothoracic surgery, typical billing practices, and associated modifiers. The summary also highlights relevant taxonomies and ICD-10 diagnoses, offering a clear understanding of how this code fits within broader cardiovascular care. Policy updates and coding trends are discussed to inform stakeholders about current standards and expectations for mitral valve repair procedures. The analysis is designed for a national audience, supporting healthcare professionals, administrators, and policy makers in navigating the complexities of surgical billing and reimbursement for mitral valvuloplasty.
CPT Code Overview
CPT code 33426 describes a valvuloplasty of the mitral valve performed with cardiopulmonary bypass. This procedure is a surgical intervention aimed at repairing the mitral valve to restore proper function, typically indicated for patients with mitral valve disease such as stenosis or insufficiency. The service falls under surgical procedures on the mitral valve and is most commonly performed in an inpatient hospital setting (Place of Service 21). This complex surgery requires specialized expertise and resources, reflecting its importance in the management of advanced cardiovascular conditions.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting with symptomatic mitral valve disease, such as mitral regurgitation or stenosis. The patient may experience symptoms like shortness of breath, fatigue, or palpitations. After diagnostic evaluation, including echocardiography, the patient is scheduled for surgical mitral valvuloplasty with cardiopulmonary bypass. The procedure is performed in an inpatient hospital setting, typically by a cardiothoracic surgeon, sometimes with assistance from another surgeon or surgical assistant. The clinical workflow includes preoperative assessment, intraoperative repair of the mitral valve, and postoperative care in a cardiac unit.
Coding Specifications
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Modifier
62(Two Surgeons): Used when two surgeons perform distinct parts of the procedure, each acting as a primary surgeon. -
Modifier
80(Assistant Surgeon): Used when an assistant surgeon provides surgical assistance during the procedure. -
Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
208600000X | Surgery |
207RC0000X | Cardiovascular Disease Physician |
These taxonomies represent providers specializing in cardiothoracic surgery, general surgery, and cardiovascular disease.
Related Diagnoses
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I34.0- Nonrheumatic mitral (valve) insufficiency- Indicates mitral regurgitation not caused by rheumatic disease; commonly treated with mitral valvuloplasty.
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I34.1- Nonrheumatic mitral (valve) prolapse- Refers to mitral valve prolapse, which can lead to regurgitation and may require surgical repair.
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I34.2- Nonrheumatic mitral (valve) stenosis- Describes narrowing of the mitral valve not due to rheumatic causes; surgical intervention may be indicated.
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I05.0- Rheumatic mitral stenosis- Stenosis resulting from rheumatic heart disease; mitral valvuloplasty is a treatment option.
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I05.1- Rheumatic mitral insufficiency- Regurgitation due to rheumatic disease; surgical repair may be necessary.
Related CPT Codes
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33425- Valvuloplasty, mitral valve, with cardiopulmonary bypass; without prosthetic ring- Related as a less complex mitral valve repair, performed without a prosthetic ring.
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33427- Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring and chordal reconstruction- Related as a more complex repair, involving prosthetic ring placement and chordal reconstruction.
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33430- Replacement, mitral valve, with cardiopulmonary bypass- Alternative procedure when repair is not feasible; involves valve replacement.
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33533- Coronary artery bypass, using arterial graft(s); single arterial graft- May be performed concurrently if coronary artery disease is present, often coded together in combined procedures.
National Reimbursement Benchmarks
For CPT code 33426, national mean rates show that Medicare reimburses at $2,242.28, while the average commercial benchmark (BUCA) is higher at $3,113.37. Commercial payers such as UnitedHealth Group and Cigna have the highest mean rates, with UnitedHealth Group at $4,338.28 and Cigna at $3,934.44.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range at $175.00, indicating relatively consistent rates. In contrast, UnitedHealth Group has the widest dispersion at $2,536.50, reflecting greater variability in contracted rates. Blue Cross Blue Shield and Cigna also show substantial ranges, at $1,503.80 and $2,183.33 respectively.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
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.