CPT 33261 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 33261: Surgical Ventricular Ablation with Cardiopulmonary Bypass

CPT code 33261 designates a cardiac surgical ablation targeting a focal ventricular arrhythmia performed with the patient on cardiopulmonary bypass. The procedure is clinically significant because it addresses life‑threatening ventricular rhythms that may not be controlled by catheter-based approaches, and it typically requires an operating room and cardiothoracic surgical resources. Nationally, procedures of this type influence hospital resource utilization, perioperative cardiac care pathways, and coverage discussions for advanced electrophysiologic and surgical therapies.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context and service setting for CPT code 33261, a summary of payer coverage considerations and common modifier usage where available, and guidance on where to find relevant policy and coding updates. The publication also provides benchmarking and utilization framing where data exists and notes when specific items are not provided.

This summary is intended for coding professionals, practice managers, and clinical leaders seeking a national overview of the code’s clinical meaning, typical site of service, and the payer landscape relevant to surgical ventricular ablation performed with cardiopulmonary bypass.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33261CPTcardiac surgeryventricular ablationcardiopulmonary bypasselectrophysiologyoperating roominpatient

Billing Code Overview

CPT code 33261 describes a surgical procedure in which the provider destroys a small area of the heart ventricle responsible for an abnormal heart rhythm while the patient is supported on cardiopulmonary bypass. This is a targeted cardiac ablation performed during an operative intervention.

Service type: Cardiac surgical ablation under cardiopulmonary bypass
Typical site of service: Inpatient operating room or cardiac surgery suite with cardiopulmonary bypass capability

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 58-year-old man with ischemic cardiomyopathy who presents with recurrent, drug-refractory ventricular tachycardia (VT) causing presyncope despite antiarrhythmic therapy and prior endocardial ablation attempts. Preoperative workup includes transthoracic and transesophageal echocardiography to assess ventricular function and structural lesions, cardiac MRI to localize scar substrate when feasible, and electrophysiology study mapping to identify the arrhythmogenic focus. The multidisciplinary team (electrophysiology, cardiothoracic surgery, anesthesiology, perfusion) plans a surgical ventricular tachycardia ablation with placement of the patient on cardiopulmonary bypass.

In the operating room under general anesthesia, the cardiothoracic surgeon performs a median sternotomy or limited thoracotomy. Cardiopulmonary bypass is instituted and myocardial exposure achieved. Electrophysiologic mapping (epicardial and/or endocardial as indicated) and intraoperative stimulation identify the target ventricular tissue. The surgeon destroys the arrhythmogenic focus by cryoablation or surgical resection/endo-epicardial ablation while on bypass. Hemostasis is confirmed, the patient is weaned from bypass, and postoperative care includes telemetry monitoring in a cardiac ICU, assessment for recurrence, and management of anticoagulation and heart failure therapies as needed.

Typical site of service: Inpatient operating room (cardiothoracic surgery) with postoperative ICU stay.

Service type: Open surgical ventricular arrhythmia ablation performed on cardiopulmonary bypass.

Coding Specifications

Modifier	Description	When to Use

CPT 33268: Left Atrial Appendage Exclusion, Open Cardiac Surgery

CPT-33256-ATRIAL-ABLATION-ATRIAL-RECONSTRUCTION

CPT 33256: Atrial Ablation with Left and Right Atrial Reconstruction

CPT-33250-CARDIAC-ARRHYTHMIA-ABLATION-NO-BYPASS

CPT 33250: Cardiac Arrhythmia Ablation Without Bypass

CPT-33251-CARDIAC-ABLATION-WITH-CARDIOPULMONARY-BYPASS

CPT 33251: Surgical Cardiac Ablation With Cardiopulmonary Bypass

CPT-33258-ATRIAL-FIBRILLATION-ATRIAL-RECONSTRUCTION-NO-BYPASS

CPT 33258: Surgical Atrial Ablation with Extensive Atrial Reconstruction

CPT-33267-LEFT-ATRIAL-APPENDAGE-EXCLUSION-OPEN-SURGERY

CPT 33267: Left Atrial Appendage Exclusion, Open Surgical Procedure

CPT-33254-ATRIAL-ABLATION-AND-ATRIAL-RECONSTRUCTION

CPT 33254: Atrial Ablation with Left and Right Atrial Reconstruction

CPT-33264-IMPLANTABLE-DEFIBRILLATOR-PULSE-GENERATOR-REPLACEMENT-THREE-CHAMBER

CPT 33264: Implantable Defibrillator Pulse Generator Removal and Replacement

CPT-33255-ATRIAL-ABLATION-AND-ATRIAL-RECONSTRUCTION-OFF-PUMP

CPT 33255: Atrial Ablation and Reconstruction, Off‑Pump

CPT-33259-EXTENSIVE-ATRIAL-ABLATION-AND-RECONSTRUCTION

CPT 33259: Extensive Atrial Ablation and Reconstruction

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Taxonomy Code	Specialty	Notes
207P00000X	Cardiothoracic Surgery	Primary surgical specialty performing open ventricular ablation on cardiopulmonary bypass.
207RC0000X	Cardiac Electrophysiology	Electrophysiologist involved in mapping and intraoperative localization of arrhythmia substrate.
208000000X	General Cardiology	Cardiologist for pre- and postoperative heart failure and arrhythmia management.
207L00000X	Thoracic Surgery	Thoracic surgeons who may perform alternative surgical approaches.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I47.2`	Ventricular tachycardia	Primary arrhythmia indication for surgical ventricular ablation when refractory to medical therapy or catheter ablation.
`I49.01`	Ventricular fibrillation	Life-threatening ventricular arrhythmia that may prompt definitive surgical substrate modification in select cases.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Underlying ischemic substrate that can create scar-related VT targeted during surgical ablation.
`I50.22`	Chronic systolic (congestive) heart failure	Common comorbidity; reduced ejection fraction patients are at higher risk for VT and may undergo surgical ablation.
`I42.0`	Dilated cardiomyopathy	Structural cardiomyopathy that often produces ventricular scar or conduction abnormalities leading to VT.
`I34.0`	Mitral (valve) insufficiency	Valvular disease that may coexist and influence surgical approach; may be addressed concurrently in some cases.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33261`	Destruction of arrhythmogenic focus in a ventricular chamber; with cardiopulmonary bypass	Primary procedure code describing open surgical ventricular arrhythmia ablation performed on cardiopulmonary bypass.
`93458`	Combined right and left heart catheterization including coronary angiography when performed; with left heart catheterization (selective coronaries)	May be performed preoperatively to assess coronary anatomy and guide revascularization planning before surgical ablation.
`93621`	Comprehensive electrophysiologic evaluation including intraoperative mapping and induction of arrhythmia	Describes detailed EP study/mapping often performed preoperatively or intraoperatively to localize VT circuits.
`33210`	Insertion of implantable cardioverter-defibrillator (ICD), single lead, with or without lead revision	ICD implantation is commonly performed before or after surgical VT ablation for secondary prevention of sudden cardiac death.
`33249`	Insertion of implantable cardioverter-defibrillator, dual or single lead, with transvenous lead(s) and subcutaneous array when performed	Alternative ICD coding when multiple leads or systems are used in conjunction with arrhythmia surgery.
`33533`	Coronary artery bypass, single arterial graft	Coronary artery bypass grafting may be performed concomitantly if significant coronary disease is identified during surgical planning.

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