CPT 33269 Left Atrial Appendage Exclusion Reimbursement | OpenPayer

Summary & Overview

CPT 33269: Left Atrial Appendage Exclusion, Thoracoscopic Procedure

CPT code 33269 represents minimally invasive thoracoscopic exclusion or excision of the left atrial appendage. The procedure is performed to exclude a small pouchlike sac in the left atrium that can be a source of thrombus formation and subsequent embolic stroke. Nationally, this code is relevant to cardiovascular surgical services, hospital procedure volumes, and policy discussions about surgical alternatives to catheter-based left atrial appendage closure.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and payer coverage landscape. The publication outlines benchmarks for utilization and reimbursement (where available), common billing considerations, and notable policy updates affecting coverage and coding practice.

This summary provides clinicians, billing professionals, and policy analysts with the clinical definition of the service, the primary settings where it occurs, and the aspects of payer policy and claims processing most likely to affect adoption and billing for CPT code 33269. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 33269left atrial appendagethoracoscopic surgerycardiac surgerysurgical exclusionprocedural codinghospital servicesambulatory surgical centerstroke prevention

Billing Code Overview

CPT code 33269 describes surgical exclusion, such as by excision, of the left atrial appendage, a small, pouchlike sac in the top left chamber of the heart. This procedure is a minimally invasive thoracoscopic surgical removal or exclusion of the left atrial appendage intended to reduce stroke risk associated with certain cardiac conditions.

Service type: Minimally invasive thoracoscopic cardiac surgery
Typical site of service: Operating room or ambulatory surgical center with thoracoscopic capability

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with nonvalvular atrial fibrillation and a high CHA2DS2-VASc score presents for elective left atrial appendage exclusion to reduce stroke risk because long-term anticoagulation is contraindicated due to recurrent gastrointestinal bleeding. Preoperative evaluation includes transthoracic and transesophageal echocardiography to confirm left atrial appendage anatomy and exclude thrombus, basic labs (CBC, BMP, coagulation panel), and anesthesia assessment. The procedure is performed in a cardiovascular operating room or hybrid catheterization suite under general anesthesia using thoracoscopic minimally invasive techniques to excise or occlude the left atrial appendage. Intraoperative transesophageal echocardiography may be used for guidance. Postoperative care includes monitoring in a post-anesthesia care unit or cardiac stepdown unit, pain control, chest tube management if placed, and surveillance for bleeding, pericardial effusion, or stroke. Discharge planning addresses anticoagulation strategy, wound care, activity restrictions, and follow-up with cardiothoracic surgery and cardiology for imaging to confirm exclusion success.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure required substantially greater work than typical (documented).

CPT 33280: Phrenic Nerve Stimulator Pulse Generator Removal

CPT-33271-SUBCUTANEOUS-IMPLANTABLE-DEFIBRILLATOR-ELECTRODE-INSERTION

CPT 33271: Subcutaneous Implantable Defibrillator Electrode Insertion

CPT-33275-LEADLESS-PACEMAKER-EXTRACTION-FEMORAL-APPROACH

CPT 33275: Removal of Leadless Pacemaker from Right Ventricle

CPT-33272-SUBCUTANEOUS-IMPLANTABLE-DEFIBRILLATOR-ELECTRODE-REMOVAL

CPT 33272: Removal of Subcutaneous Implantable Defibrillator Electrode

CPT-33277-PHRENIC-NERVE-STIMULATOR-SENSING-LEAD-INSERTION

CPT 33277: Sensing Lead Insertion During Phrenic Nerve Stimulator Procedure

CPT-33265-ENDOSCOPIC-ATRIAL-ABLATION-AND-RECONSTRUCTION

CPT 33265: Endoscopic Atrial Ablation and Reconstruction

CPT-33273-REPOSITION-SUBCUTANEOUS-IMPLANTABLE-DEFIBRILLATOR-ELECTRODE

CPT 33273: Reposition Subcutaneous Implantable Defibrillator Electrode

CPT-33274-LEADLESS-PACEMAKER-INSERTION-RIGHT-VENTRICLE-FEMORAL-APPROACH

CPT 33274: Leadless Pacemaker Insertion or Replacement, Right Ventricle

CPT-33266-MAZE-PROCEDURE-ENDOSCOPIC-ATRIAL-ABLATION-NO-BYPASS

CPT 33266: Endoscopic Maze Procedure for Atrial Fibrillation (No Bypass)

CPT-33276-PHRENIC-NERVE-STIMULATOR-IMPLANTATION

CPT 33276: Phrenic Nerve Stimulator System Implantation

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Taxonomy Code	Specialty	Notes
207L00000X	Cardiothoracic Surgery	Primary specialty performing thoracoscopic left atrial appendage exclusion.
207RC0000X	Interventional Cardiology	May be involved in preoperative evaluation and hybrid procedures.
207RP1001X	Cardiac Electrophysiology	Involved when arrhythmia management and left atrial appendage exclusion are coordinated.
207Q00000X	Thoracic Surgery	Performs minimally invasive thoracoscopic approaches.
363A00000X	Anesthesiology	Provides general anesthesia and intraoperative monitoring support.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I48.2`	Chronic atrial fibrillation	Common indication when stroke risk reduction is needed.
`I48.91`	Unspecified atrial fibrillation	General AF diagnosis prompting consideration of left atrial appendage exclusion.
`I48.11`	Longstanding persistent atrial fibrillation	Indicates sustained AF where LAA exclusion may reduce thromboembolic risk.
`D68.9`	Coagulation defect, unspecified	Relevant when anticoagulation is contraindicated, prompting procedural stroke prevention.
`K92.2`	Gastrointestinal hemorrhage, unspecified	Prior GI bleeding is a frequent reason to avoid anticoagulation and pursue LAA exclusion.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33207`	Insertion of leadless pacemaker, transcatheter	May be performed before or after when bradyarrhythmia management is needed in patients with atrial fibrillation.
`33210`	Insertion of epicardial pacemaker or electrode, with or without subcutaneous generator, open or thoracoscopic	Related when concomitant epicardial lead placement is required during thoracoscopic cardiac surgery.
`33208`	Removal and replacement of permanent pacemaker lead, epicardial	Performed if existing epicardial hardware needs revision during the same operative session.
`33216`	Removal of pacemaker pulse generator with replacement (separate procedure)	Relevant if device management is required in the same hospitalization.
`93452`	Left heart catheterization including coronary angiography when performed; with left ventriculography when performed	May be performed preoperatively in hybrid cases to assess coronary anatomy or concurrently in a hybrid suite.
`93312`	Echocardiography, transesophageal, real-time with image documentation (2D), including M-mode when performed; without probe guidance for other procedures	Intraoperative TEE is commonly billed to guide placement and confirm exclusion; use `26` for professional component when applicable.

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