Summary & Overview
CPT 0806T: Vena Cava Prosthetic Valve Implantation via Femoral Vein
CPT code 0806T denotes an open femoral vein approach for catheter-based implantation of prosthetic valves in the vena cava. This endovascular procedure addresses venous valve dysfunction or pathology requiring prosthetic replacement and represents a specialized vascular intervention that may affect hospital procedural mix, device utilization, and payer coverage decisions nationally. Key payers relevant to coverage and reimbursement considerations include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication provides a concise national overview of CPT code 0806T, explaining the clinical purpose and typical delivery setting, and outlines what readers will find: benchmark metrics where available, common billing and coding considerations, and clinical context for the procedure. The report is intended for revenue cycle leaders, coding and compliance staff, and clinical program managers who need a succinct reference on an emerging endovascular vena cava valve implantation code. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 0806T describes a procedure in which the provider uses an open femoral vein approach to implant prosthetic valves in the vena cava using a catheter. This is an endovascular valve implantation procedure targeting the venous system rather than the heart's native valves.
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Service type: Endovascular prosthetic vena cava valve implantation
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Typical site of service: Hospital-based vascular operating room or interventional suite (inpatient or outpatient hospital setting)
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Clinical & Coding Specifications
Clinical Context
A typical patient is an older adult with symptomatic venous insufficiency or severe tricuspid regurgitation being treated with caval valve implantation as an alternative to surgical repair. The patient presents with progressive peripheral edema, ascites, or refractory right-sided heart failure symptoms despite optimized medical therapy. Pre-procedure evaluation includes transthoracic and transesophageal echocardiography, right heart catheterization, venous duplex imaging, and CT venography to assess caval anatomy and rule out thrombus.
On the day of service the procedure is performed in an interventional suite or hybrid operating room under moderate sedation or general anesthesia. Vascular access is obtained via an open femoral vein approach; sheaths are placed and a catheter-based delivery system advances a prosthetic valve into the inferior or superior vena cava under fluoroscopic and echocardiographic guidance. Valve deployment is confirmed by imaging and hemodynamic measurements. Post-deployment, hemostasis at the femoral vein is achieved, and the patient is monitored in a post-anesthesia care unit or inpatient setting for complications such as bleeding, access site issues, valve malposition, or pulmonary embolism. Typical length of stay ranges from same-day observation to 1–3 days depending on clinical stability and comorbidities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for (document rationale and quantify additional work). |