Summary & Overview
CPT 33340: Percutaneous Left Atrial Appendage Occlusion Device Implantation
CPT code 33340 defines percutaneous transcatheter implantation of a left atrial appendage occlusion device delivered via a catheter across the atrial septum, with fluoroscopic guidance and angiographic visualization as needed. This procedure is a minimally invasive alternative to surgical approaches for excluding the left atrial appendage, a common source of thromboembolism in patients with atrial fibrillation. Nationally, utilization of device-based left atrial appendage occlusion has implications for stroke prevention strategies, specialty procedural volumes, and hospital-based interventional cardiology capacity.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary addresses coverage and billing patterns observed with these major public and private payers and highlights areas where policy language and prior authorization practices commonly influence access.
Readers will find concise clinical context describing the procedure, benchmarks for site-of-service utilization and typical care settings, and an outline of payer coverage themes and documentation expectations. The publication also summarizes recent policy updates and billing considerations relevant to coding, medical necessity documentation, and imaging interpretation that often accompany claims for this procedure. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 33340 describes percutaneous transcatheter implantation of a device delivered through a catheter placed through the skin and advanced across the atrial septum to occlude the left atrial appendage. The procedure includes use of fluoroscopic guidance to position the device and the use of angiography to visualize and define the left atrium and left atrial appendage when necessary, as well as interpretation of angiographic imaging if performed.
-
Service type: Percutaneous transcatheter left atrial appendage occlusion with imaging guidance
-
Typical site of service: Hospital-based catheterization laboratory or interventional cardiology suite
Clinical & Coding Specifications
Clinical Context
A 76-year-old patient with nonvalvular atrial fibrillation and high thromboembolic risk (CHA2DS2-VASc score ≥3) with a contraindication to long-term oral anticoagulation presents for percutaneous left atrial appendage occlusion. The patient undergoes pre-procedure evaluation including transesophageal echocardiography (TEE) and contrast-enhanced CT or intracardiac echocardiography (ICE) to define appendage anatomy. On the day of service the patient is admitted to the cardiac catheterization or hybrid operating room under general anesthesia or monitored sedation. Vascular access is obtained percutaneously (typically femoral venous), transseptal puncture is performed under fluoroscopic and echocardiographic guidance, and the closure device is delivered through a transcatheter sheath and positioned in the left atrial appendage. Angiography of the left atrium and appendage is performed as needed to visualize anatomy and confirm device placement and seal; the interpreting physician documents angiographic findings and final device position. The typical site of service is an inpatient or outpatient hospital cardiac catheterization laboratory or hybrid operating room. Usual clinical workflow includes pre-procedure imaging and consent, intra-procedure device deployment with fluoroscopy and angiography, immediate post-deployment imaging (TEE/ICE and angiography), and brief post-procedure monitoring with possible overnight observation depending on institutional practice and patient comorbidities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default, no modifier |