Summary & Overview
CPT 0545T: Transcatheter Adjustable Annulus Device for Tricuspid Regurgitation
CPT code 0545T identifies a transcatheter procedure that inserts an adjustable annulus device across the interatrial septum to reconstruct and tighten a dilated tricuspid valve annulus for treatment of tricuspid regurgitation. As a novel structural heart intervention, this code captures a minimally invasive alternative to open surgical repair for patients with clinically significant tricuspid regurgitation and dilated annulus. Nationally, adoption of transcatheter tricuspid therapies is a growing area of cardiovascular care due to an aging population and increasing recognition of adverse outcomes associated with untreated tricuspid disease.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing overview of the procedure, typical sites of service, common modifier usage (for reference), and notes on payer coverage patterns where available. The publication also situates the code in the broader context of structural heart interventions and highlights what to expect in terms of clinical indications and care settings.
This summary serves clinicians, coding professionals, and policy analysts seeking a concise briefing on what CPT code 0545T represents, why it matters for cardiac care delivery, and which major payers are most relevant to coverage and claims discussions. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 0545T describes a percutaneous, transseptal insertion of an adjustable annulus device to reconstruct and tighten a dilated tricuspid valve annulus for treatment of tricuspid regurgitation. The procedure involves catheter-based delivery across the interatrial septum to reshape the tricuspid valve annulus.
Service type: Transcatheter tricuspid annuloplasty (device insertion)
Typical site of service: Hospital outpatient or inpatient cardiac catheterization laboratory / hybrid operating room, with interventional cardiology or cardiac surgery teams performing the procedure.
Clinical & Coding Specifications
Clinical Context
A typical patient is an older adult with symptomatic, moderate-to-severe tricuspid regurgitation due to annular dilation and right-sided heart chamber enlargement. The patient commonly presents with worsening exertional dyspnea, fatigue, peripheral edema, and signs of right-sided heart failure despite optimal medical therapy (diuretics, guideline-directed therapy for concomitant left-sided disease). Evaluation includes transthoracic and transesophageal echocardiography confirming tricuspid annular dilation and regurgitant jet severity, right heart catheterization when indicated, and multidisciplinary Heart Team review. The procedure is performed in a cardiac catheterization laboratory or hybrid operating room under general anesthesia or conscious sedation with transesophageal echocardiographic and fluoroscopic guidance. A catheter is advanced percutaneously through the femoral or jugular venous access, across the interatrial septum if required by the device approach, and an adjustable annuloplasty device is deployed and tightened to reconstruct the tricuspid annulus. Post-procedure care includes telemetry monitoring, serial echocardiography to assess valve competence, anticoagulation management per device instructions, and inpatient observation typically 1–3 days with outpatient follow-up and echocardiographic surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or technical effort substantially exceeds the typical service for and documentation supports medical necessity for extra work. |