Summary & Overview
CPT 33368: Cardiopulmonary Bypass During Primary TAVI/TAVR
Headline: New CPT code 33368 specifies cardiopulmonary bypass for TAVI/TAVR with open peripheral cannulation
Lead: CPT code 33368 designates use of cardiopulmonary bypass (CPB) during a primary transcatheter aortic valve implantation/transcatheter aortic valve replacement (TAVI/TAVR) when open peripheral arterial and venous cannulation is performed. The code clarifies billing for hybrid procedures that combine transcatheter valve replacement with surgical cannulation for extracorporeal support.
CPT code 33368 matters nationally because TAVI/TAVR volumes continue to grow and hospitals increasingly perform complex hybrid procedures that may require CPB. Clear coding for CPB during TAVI/TAVR affects hospital billing, case classification, and resource tracking for high-acuity cardiac services. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical scope and intended use of the code, the typical site of service and service type, and which major payers are considered in payer coverage discussion. The publication also outlines benchmark and policy context relevant to billing and coding for hybrid TAVI/TAVR procedures, and identifies areas where input was not provided. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 33368 reports the use of cardiopulmonary bypass (CPB) during a primary transcatheter aortic valve implantation/transcatheter aortic valve replacement (TAVI/TAVR) service. This code is specific to CPB that involves open peripheral arterial and venous cannulation, indicating a hybrid procedural approach that combines transcatheter valve replacement with surgical vascular access for extracorporeal circulatory support.
Service type: Intraoperative cardiopulmonary bypass support during primary TAVI/TAVR
Typical site of service: Hospital operating room or hybrid cardiac catheterization/operating suite where TAVI/TAVR procedures with surgical cannulation and extracorporeal support are performed
Clinical & Coding Specifications
Clinical Context
A 78-year-old patient with severe, symptomatic calcific aortic stenosis is evaluated for transcatheter aortic valve implantation/replacement (TAVI/TAVR). The heart team determines percutaneous transfemoral access is high risk due to peripheral vascular disease, so a transapical or transfemoral TAVR is planned with anticipated need for cardiopulmonary bypass (CPB) via open peripheral arterial and venous cannulation. The patient is brought to the hybrid operating room where cardiothoracic surgery, interventional cardiology, anesthesia, perfusion, and vascular surgery teams coordinate care. After induction of general anesthesia and transesophageal echocardiography guidance, peripheral arterial and venous cannulation is performed through open exposures (usually femoral vessels) to establish CPB before valve deployment. CPB is used to support circulation if hemodynamic instability occurs during valve deployment or to facilitate rapid conversion to open surgery. Postprocedure, the patient is transferred to the cardiac intensive care unit for hemodynamic monitoring and recovery, with perfusion decannulation, wound closure, and vascular assessments completed in the OR.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no other modifier applies |
11 |