Summary & Overview
CPT 33365: Transaortic Transcatheter Aortic Valve Replacement (TAVR)
CPT code 33365 represents a transcatheter aortic valve replacement (TAVR/TAVI) performed specifically via a transaortic approach. This procedure involves delivering and deploying a replacement aortic valve through the lumen of a catheter introduced directly through the aorta. Nationally, TAVR is a high-acuity, resource-intensive structural heart intervention with growing clinical and policy attention because of its role in treating aortic valve disease in diverse risk populations.
Key payers addressed in related billing analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise view of clinical context for CPT code 33365, typical sites of service, common billing modifiers (listed separately), and what to expect in payer coverage patterns and billing benchmarks at a national level. The publication also summarizes coding relationships and areas where policy updates or payer-specific edits commonly affect claims for transcatheter aortic valve procedures.
This summary provides clinicians, coding professionals, and payer analysts an executive snapshot of the procedure code, its clinical setting, and the scope of issues that influence reimbursement and utilization reporting for transaortic TAVR services.
Billing Code Overview
CPT code 33365 describes a transcatheter aortic valve replacement (TAVR/TAVI) procedure performed via a transaortic approach, in which the provider inserts a replacement aortic valve through the lumen of a catheter introduced directly through the aorta. The service type is transcatheter aortic valve replacement (TAVR/TAVI) using a transaortic access route. The typical site of service is an operating room or hybrid catheterization/cardiac procedural suite equipped for structural heart interventions and cardiac surgery.
Clinical & Coding Specifications
Clinical Context
A typical patient is an 78-year-old with symptomatic severe aortic stenosis—progressive exertional dyspnea, angina, or syncope—deemed high or prohibitive risk for open surgical aortic valve replacement. Pre-procedure evaluation includes transthoracic and transesophageal echocardiography confirming severe calcific aortic stenosis, cardiac CT for annular sizing and vascular access planning, coronary angiography as indicated, and multidisciplinary heart team review. The patient is admitted to an interventional hybrid operating room or cardiac catheterization laboratory on the day of procedure. Under general anesthesia or monitored anesthesia care, vascular access is obtained and a transaortic transcatheter aortic valve replacement (TAVR) is performed via a direct transaortic approach through a minimal sternotomy or upper hemisternotomy with catheter delivery across the native valve and deployment of a prosthetic aortic valve. Intra-procedural imaging (fluoroscopy and transesophageal echocardiography) guides valve positioning and deployment. Post-procedure, the patient is observed in a cardiac intensive care or step-down unit for hemodynamic monitoring, rhythm surveillance (risk of conduction disturbance), and vascular access site assessment. Typical discharge occurs within 2–5 days if uncomplicated, with follow-up for echocardiographic assessment and anticoagulation or antiplatelet management as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |