CPT 33363 TAVR Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 33363: Transcatheter Aortic Valve Replacement via Open Axillary Artery Approach

CPT code 33363 represents transcatheter aortic valve replacement (TAVR/TAVI) performed via an open axillary artery approach. This procedure is a specialized structural heart intervention in which the aortic valve prosthesis is delivered through the lumen of a catheter introduced surgically via the axillary artery. Nationally, TAVR codes are clinically and financially significant due to high procedure complexity, inpatient resource use, and growing utilization among patients with aortic valve disease.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The review addresses payer coverage practices, claim coding considerations, and common modifiers tied to procedural reporting.

Readers will find a concise policy and billing overview, clinical context for the open axillary access route, and benchmarks relevant to coding and site-of-service placement. The content highlights where 33363 fits within structural heart procedures, typical hospital-based settings for delivery, and information gaps where input data is not available. Data not available in the input includes specific associated taxonomies, ICD-10 diagnosis codes, related codes, and payer-specific reimbursement rates.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 33363TAVRTranscatheter Aortic Valve ReplacementStructural HeartAxillary Artery AccessCardiac SurgeryHospital InpatientHybrid ORProcedure CodingCardiology

Billing Code Overview

CPT code 33363 describes transcatheter aortic valve replacement (TAVR/TAVI) performed by inserting an aortic valve prosthesis through the lumen of a catheter using an open axillary artery approach. The procedure involves accessing the axillary artery surgically to introduce the delivery catheter and deploy a replacement aortic valve.

Service Type

Service Type: Transcatheter aortic valve replacement via open axillary artery approach

Typical Site of Service

Typical Site of Service: Hospital operating room or hybrid cardiac catheterization/operating suite for structural heart procedures

Clinical & Coding Specifications

Clinical Context

A 78-year-old patient with symptomatic severe aortic stenosis and multiple comorbidities (e.g., chronic obstructive pulmonary disease, chronic kidney disease stage 3, and prior coronary artery bypass grafting) is evaluated by a multidisciplinary heart team and deemed high risk for conventional open surgical aortic valve replacement. The patient is scheduled for a transcatheter aortic valve implantation/replacement (TAVI/TAVR) using an axillary (open axillary artery) surgical approach because peripheral arterial disease or small, tortuous iliofemoral vessels preclude transfemoral access. Pre-procedure workflow includes preoperative imaging (CT angiography of the aorta and iliac/axillary vessels), anesthetic evaluation, and informed consent discussing axillary access risks. In the operating room or hybrid catheterization lab, an arterial cutdown is performed on the axillary artery for direct catheter introduction. The interventional cardiologist or cardiothoracic surgeon advances the delivery catheter and deploys the transcatheter aortic valve under fluoroscopic and echocardiographic guidance. Hemostasis at the axillary access site is achieved surgically, and the patient is transferred to a monitored unit for post-procedure observation with vascular and neurologic checks, anticoagulation management, and echocardiographic assessment of valve function prior to discharge or transfer to step-down care.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	Use when two surgeons of different specialties operate together and both perform distinct portions of a TAVR via axillary approach.

CPT 33390: Open Aortic Valve Repair with Cardiopulmonary Bypass

CPT-33369-CPB-CENTRAL-CANNULATION-DURING-TAVR

CPT 33369: Cardiopulmonary Bypass with Central Cannulation During TAVI/TAVR

CPT-33412-AORTIC-VALVE-REPLACEMENT-ANNULAR-ENLARGEMENT-KONNO

CPT 33412: Aortic Valve Replacement with Annular Enlargement or Konno Procedure

CPT-33405-AORTIC-VALVE-REPLACEMENT-OPEN-BYPASS

CPT 33405: Aortic Valve Replacement, Open with Cardiopulmonary Bypass

CPT-33391-AORTIC-VALVE-RECONSTRUCTION-OPEN-CPB

CPT 33391: Aortic Valve Reconstruction, Open with Cardiopulmonary Bypass

CPT-33364-TRANSCATHETER-AORTIC-VALVE-REPLACEMENT-ILIAC-ARTERY-APPROACH

CPT 33364: Transcatheter Aortic Valve Replacement via Open Iliac Artery Approach

CPT-33440-AORTIC-VALVE-REPLACEMENT-ROSS-PROCEDURE-ANNULAR-ENLARGEMENT

CPT 33440: Aortic Valve Replacement with Pulmonary Autograft and Conduit

CPT-33366-TRANSAPICAL-TRANSCATHETER-AORTIC-VALVE-REPLACEMENT-TAVR-TAVI

CPT 33366: Transapical Transcatheter Aortic Valve Replacement (TAVR/TAVI)

CPT-33413-ROSS-PROCEDURE-AORTIC-VALVE-REPLACEMENT-WITH-PULMONARY-AUTOGRAFT

CPT 33413: Ross Procedure — Aortic Valve Replacement with Pulmonary Autograft

CPT-33361-TRANSCATHETER-AORTIC-VALVE-REPLACEMENT-FEMORAL

CPT 33361: Transcatheter Aortic Valve Replacement, Percutaneous Femoral Approach

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Taxonomy Code	Specialty	Notes
207RC0000X	Interventional Cardiology	Interventional cardiologists commonly perform TAVR delivery and deployment.
208100000X	Thoracic and Cardiovascular Surgery	Cardiothoracic surgeons perform axillary open access and valve implantation in hybrid settings.
207RP1001X	Interventional Cardiology - Adult	Subspecialty interventionalists who perform structural heart interventions.
2080S0124X	Cardiac Surgery	Cardiac surgeons involved in complex access and surgical management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I35.0`	Nonrheumatic aortic (valve) stenosis	Primary indication for TAVR due to severe symptomatic aortic stenosis.
`I35.1`	Nonrheumatic aortic (valve) insufficiency	Aortic regurgitation that may be an indication for valve replacement depending on severity and symptoms.
`I06.0`	Rheumatic aortic stenosis	Less common in TAVR population but relevant when rheumatic disease is present.
`I33.0`	Acute and subacute infective endocarditis	May require valve intervention; active infection usually alters timing of TAVR.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Common comorbidity in patients undergoing TAVR that affects perioperative risk and planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33361`	Transcatheter aortic valve replacement (TAVR/TAVI) initial insertion of prosthetic valve with transfemoral or trans-septal arterial approach	Alternative access approach codes contrast with `33363` which is specific to open axillary artery access; used when transfemoral delivery is performed.
`33364`	Transcatheter aortic valve replacement, each additional valve prosthesis implanted during the same session (list with primary procedure)	Used when more than one valve prosthesis is implanted during the same operative session following `33363`.
`36247`	Selective catheter placement, arterial system; each first order thoracic branch, for diagnostic or therapeutic catheterization	May be reported for diagnostic catheter work during vascular access and imaging in the procedural workflow.
`93503`	Insertion and placement of catheter, arterial, for angiography, percutaneous	Ancillary vascular catheterization and imaging procedures performed during TAVR access and guidance.
`76937`	Ultrasonic guidance for vascular access (e.g., for axillary artery puncture)	Used when ultrasound guidance is documented for axillary arterial access during the procedure.

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