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    v1.0.28
    OpenPayerBilling CodesSurgical Procedures on the PericardiumCPT cpt-33025-pericardial-window-pericardiotomy-drainage
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    CPT 33025: Pericardial Window to Drain Pericardial Fluid

    Medicare pays $746 on average nationally for this procedure.

    CPT code 33025 describes a surgical procedure to create an opening in the pericardium to facilitate drainage of pericardial fluid; this is a pericardial window (pericardiostomy) procedure performed by a surgical provider, typically as an operative pericardial drainage service in an inpatient or operating room setting to relieve cardiac tamponade or recurrent pericardial effusion.

    For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 62-year-old man presenting to the emergency department with progressive dyspnea, hypotension, and elevated jugular venous pressure. Echocardiography demonstrates a large pericardial effusion with early signs of cardiac tamponade. The cardiothoracic surgeon or interventional cardiologist is consulted. After hemodynamic stabilization and informed consent, the patient is taken to the cardiac catheterization laboratory or operating room. Under sterile conditions and with appropriate anesthesia (general or monitored anesthesia care), a subxiphoid pericardial window is created: the provider makes an incision, dissects to the pericardium, and creates an opening to allow drainage of pericardial fluid and to place a drain if required. Specimens of fluid may be sent for cytology, Gram stain/culture, and chemistry. The patient is monitored post-procedure in a step-down or intensive care setting for recurrent effusion, bleeding, infection, and hemodynamic recovery. Typical sites of service are the operating room, procedure room, or cardiac catheterization laboratory, with post-procedure recovery in PACU, ICU, or cardiac step-down unit. Common clinical indications include pericardial tamponade, large symptomatic pericardial effusion, malignant pericardial effusion requiring drainage, or purulent pericarditis requiring surgical drainage.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    33020Pericardiocentesis, including imaging guidance when performed; initial needle aspirationLess invasive alternative to surgical pericardial window; often performed for diagnostic or therapeutic drainage prior to or instead of 33025.
    33026Pericardiotomy with creation of a window by subxiphoid or thoracoscopic approach; with pericardial biopsyClosely related surgical codes; 33026 may be reported when a pericardial biopsy is performed in conjunction with window creation.
    99291Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutesUsed for pre- or post-procedure critical care management when the patient requires intensive support for tamponade or shock.
    32551Tube thoracostomy, includes insertion of chest tube for drainage (e.g., pleural effusion)May be performed concurrently if thoracic drainage is required in addition to pericardial drainage.
    36556Placement of non-tunneled centrally inserted central venous catheter, age 5 years or olderCommonly performed for central access for vasoactive medications and monitoring during perioperative care.

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    207RP1001XPulmonary Disease PhysicianAn internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational an…
    207RH0002XHospice and Palliative Medicine (Internal Medicine) PhysicianAn internal medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illne…
    208800000XUrology PhysicianA urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has compreh…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    2084F0202XForensic Psychiatry PhysicianForensic Psychiatry is a subspecialty with psychiatric focus on interrelationships with civil, criminal and administrative law, evaluation and special…
    261QR0200XRadiology Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    3336M0002XMail Order PharmacyA pharmacy where pharmacists compound or dispense prescriptions or other medications in accordance with federal and state law, using common carriers t…

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    A41.9Sepsis, unspecified organism
    I21.9Acute myocardial infarction, unspecified
    I25.9Chronic ischemic heart disease, unspecified
    I30.0Acute nonspecific idiopathic pericarditis
    I30.1Infective pericarditis
    I30.9Acute pericarditis, unspecified
    I31.0Chronic adhesive pericarditis
    I31.2Hemopericardium, not elsewhere classified
    I31.4Cardiac tamponade
    I31.8Other specified diseases of pericardium

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21
    Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_BlocksCigna2026-05-15
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01

    Related Codes

    CPT-33016-PERICARDIOCENTESIS-PERCUTANEOUS-DRAINAGE

    CPT 33016: Percutaneous Pericardial Drainage (Pericardiocentesis)

    CPT-33017-PERCUTANEOUS-PERICARDIAL-DRAINAGE-CATHETER

    CPT 33017: Percutaneous Pericardial Drainage with Indwelling Catheter

    CPT-33018-PERCUTANEOUS-PERICARDIAL-DRAINAGE-CATHETER-PLACEMENT-PEDIATRIC-CONGENITAL

    CPT 33018: Percutaneous Pericardial Drainage with Indwelling Catheter

    CPT-33019-PERICARDIAL-DRAINAGE-WITH-INDWELLING-CATHETER

    CPT 33019: Percutaneous Pericardial Catheter Drainage

    CPT-33020-PERICARDIAL-CLOT-FOREIGN-BODY-REMOVAL

    CPT 33020: Removal of Clot or Foreign Body from Pericardial Space

    CPT-33030-PERICARDIAL-TISSUE-REMOVAL-WITHOUT-CPB

    CPT 33030: Pericardial Debridement Without Cardiopulmonary Bypass

    CPT-33031-PERICARDIECTOMY-CARDIOPULMONARY-BYPASS

    CPT 33031: Pericardiectomy with Cardiopulmonary Bypass

    CPT-33050-PERICARDIAL-TUMOR-CYST-EXCISION

    CPT 33050: Pericardial Tumor or Cyst Excision

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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