CPT 33364 TAVR Reimbursement & Benchmarks | OpenPayer

Summary & Overview

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

CPT code 33364 covers transcatheter aortic valve replacement (TAVR/TAVI) performed by delivering an aortic valve prosthesis through a catheter lumen using an open iliac artery approach. Nationally, TAVR has become a cornerstone therapy for aortic stenosis across risk profiles, and this code captures the subset of procedures that require surgical iliac exposure to enable catheter-based valve insertion. The code matters for hospitals and specialty practices that manage complex vascular access or have hybrid suite capabilities.

Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the iliac artery access technique, billing and coding considerations tied to the procedure type, and the payer landscape relevant to coverage and reimbursement patterns. The publication also outlines common modifiers and procedural setting considerations, and highlights where Data not available in the input prevents presentation of detailed payer-specific benchmarks or diagnosis crosswalks.

This summary is intended for clinicians, coding professionals, and health policy analysts seeking a national-level briefing on CPT code 33364, its clinical role in TAVR programs, and the payer mix typically involved in coverage decisions and claims processing.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 33364transcatheter aortic valve replacementTAVRiliac artery accesscardiothoracic surgeryinterventional cardiologyhybrid operating roomvascular accessprocedural codinghospital billing

Billing Code Overview

CPT code 33364 describes a transcatheter aortic valve replacement (TAVR/TAVI) procedure in which the provider inserts an aortic valve prosthesis through the lumen of a catheter using an open iliac artery approach. This procedure is a form of percutaneous aortic valve replacement delivered via the iliac artery after surgical exposure, combining endovascular valve deployment with an open vascular access technique.

Service type: Transcatheter aortic valve insertion via open iliac artery approach (TAVR/TAVI)
Typical site of service: Hospital operating room or hybrid operating room with surgical vascular access and interventional cardiology or cardiothoracic surgery team present.

Clinical & Coding Specifications

Clinical Context

A typical patient is an 80-year-old male with symptomatic severe aortic stenosis (exertional dyspnea, syncope, or heart failure symptoms) who is evaluated by a multidisciplinary heart team and deemed a candidate for transcatheter aortic valve implantation (TAVI/TAVR) via an open iliac artery approach due to unsuitable transfemoral access (peripheral arterial disease or small/calciﬁed femoral arteries). The clinical workflow includes pre-procedure assessment (history, medication review, transthoracic echocardiogram, transesophageal or CT angiography for vascular and annular sizing), informed consent, perioperative anesthesia evaluation (general anesthesia or monitored anesthesia care), and hybrid operating room or catheterization lab preparation.

Intra-procedural steps: surgical exposure of the iliac artery, systemic anticoagulation, insertion of a large-bore vascular sheath through the open iliac artery, advancement of the delivery catheter across the native aortic valve, deployment of the transcatheter aortic valve prosthesis, assessment of valve function with intraoperative imaging (angiography and/or transesophageal echocardiography), and achievement of hemostasis at the iliac arteriotomy with vascular repair.

Post-procedure care includes monitoring in a cardiac recovery unit or ICU for hemodynamics and conduction disturbances (possible need for temporary or permanent pacemaker), pain control, vascular site assessment, anticoagulation management, and discharge planning with follow-up echocardiography and cardiology clinic visits.

Typical site of service: hybrid operating room or catheterization laboratory with surgical capability.

Service type: surgical transcatheter aortic valve replacement using an open iliac artery approach (TAVR via open iliac access).

Coding Specifications

Modifier	Description

CPT 33405: Aortic Valve Replacement, Open with Cardiopulmonary Bypass

CPT-33370-CEREBRAL-EMBOLIC-PROTECTION-TAVR

CPT 33370: Cerebral Embolic Protection During TAVR

CPT-33414-LEFT-VENTRICULAR-OUTFLOW-TRACT-PATCH-ENLARGEMENT

CPT 33414: Left Ventricular Outflow Tract Patch Enlargement

CPT-33368-CARDIOPULMONARY-BYPASS-DURING-TAVI-TAVR-OPEN-PERIPHERAL-CANNULATION

CPT 33368: Cardiopulmonary Bypass During Primary TAVI/TAVR

CPT-33390-AORTIC-VALVE-REPAIR-OPEN-SURGERY-CPB

CPT 33390: Open Aortic Valve Repair with Cardiopulmonary Bypass

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

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

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

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

CPT-33415-SUBVALVULAR-AORTIC-STENOSIS-SURGICAL-RESECTION

CPT 33415: Subvalvular Aortic Stenosis Resection

CPT-33365-TRANSAORTIC-TRANSCATHETER-AORTIC-VALVE-REPLACEMENT-TAVR

CPT 33365: Transaortic Transcatheter Aortic Valve Replacement (TAVR)

CPT-33417-AORTOPLASTY-SUPRAVALVULAR-STENOSIS-REPAIR

CPT 33417: Aortoplasty for Supravalvular Aortic Stenosis

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Taxonomy Code	Specialty	Notes
207RC0000X	Cardiac Surgery	Surgical specialists who perform open or hybrid access TAVR procedures.
207RG0100X	Interventional Cardiology	Cardiologists trained in transcatheter valve therapies who may perform deployment and imaging guidance.
207RH0004X	Vascular Surgery	Vascular surgeons who provide open iliac exposure and vascular access management.
208100000X	Cardiovascular Thoracic Surgery	Surgeons with thoracic focus participating in complex TAVR access strategies.
363L00000X	Anesthesiology	Anesthesiologists providing general or monitored anesthesia care for TAVR procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I35.0`	Nonrheumatic aortic (valve) stenosis	Primary indication for TAVR in patients with symptomatic severe aortic stenosis.
`I35.1`	Nonrheumatic aortic (valve) insufficiency	Aortic regurgitation may coexist and influence valve sizing and procedure planning.
`I35.8`	Other nonrheumatic aortic valve disorders	Other degenerative aortic valve diseases that may necessitate valve replacement.
`I06.0`	Rheumatic aortic stenosis	Less common; historic rheumatic disease leading to aortic valve pathology considered in surgical planning.
`I08.0`	Nonrheumatic aortic and mitral valve disorders	Multivalvular disease that may affect candidacy and procedural approach.
`I48.91`	Unspecified atrial fibrillation	Common comorbidity requiring peri-procedural anticoagulation management.
`I70.201`	Atherosclerosis of native arteries of extremities, unspecified right leg	Peripheral arterial disease frequently drives selection of alternative access such as open iliac approach.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33364`	Transcatheter aortic valve replacement (TAVR) via open iliac artery approach	Principal procedure code describing insertion and deployment of a transcatheter aortic valve through an open iliac artery access.
`92980`	Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery and/or branch	May be performed prior to or during TAVR in patients requiring concomitant coronary intervention.
`33361`	Transcatheter aortic valve replacement (TAVR) via transfemoral approach	Alternative TAVR access code; chosen when transfemoral percutaneous access is used instead of open iliac.
`36200`	Introduction of catheter, aorta, thoracic; diagnostic	Diagnostic aortic catheterization or angiography performed intraoperatively for vascular or valve assessment.
`93452`	Injection procedure during cardiac catheterization with imaging for left heart, including aortography when performed	Intraoperative imaging to evaluate valve position and function during TAVR deployment.
`33999`	Unlisted procedure, vascular surgery	Used for ancillary open vascular access procedures not described by a specific CPT when necessary; use only when no appropriate code exists.

`11`	Office or other outpatient service as the basic level	Use when the procedure is performed as described without unusual circumstances (provider’s default).
`22`	Increased procedural services	Use when work required is substantially greater than typical (unexpected complexities, extended operative time).
`23`	Unusual anesthesia	Use when general anesthesia is medically contraindicated and unusual anesthesia circumstances apply.
`50`	Bilateral procedure	Use only if bilateral procedures are performed during the same operative session (rare for TAVR).
`51`	Multiple procedures	Use when other unrelated surgical procedures are performed at the same session in addition to the TAVR.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use if the procedure is started but aborted due to patient-related complications prior to completion.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the operation.
`63`	Procedure performed on infants less than 4 kg	Rarely applicable; include only if patient meets criteria.
`66`	Surgical team approach	Use when a surgical team (multiple specialists) performs distinct work in a coordinated fashion.
`78`	Return to operating room for related procedure during postoperative period	Use if the patient returns to OR for a related procedure during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon is required and documented.
`81`	Minimum assistant surgeon	Use when a minimal assistant is documented.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when a PA/NP/CNS serves as assistant in states and situations where allowed.

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