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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.

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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

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Find policies, billing codes, payers, states, and providers

CPT 33368: Cardiopulmonary Bypass During Primary TAVI/TAVR

Headline: New CPT code 33368 specifies cardiopulmonary bypass for TAVI/TAVR with open peripheral cannulation

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Get alerted when payer policies referencing 33368 are released or updated.

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Billing Code Overview

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`	Duplicate of service by same physician	When service is a repeat procedural report by the same physician in error — rarely used for operative CPTs
`22`	Increased procedural services	When work, time, or complexity is significantly greater than usual for the CPB cannulation portion
`52`	Reduced services	When CPB cannulation is attempted but not fully completed or service is partially reduced
`53`	Discontinued procedure	When CPB setup is begun but procedure is terminated for patient safety before completion
`62`	Two surgeons	When two surgeons work together as primary surgeons for the CPB cannulation or conversion to open surgery
`63`	Procedure performed on infants/neonates	Use only when patient age qualifies — uncommon for this adult TAVR-related code
`66`	Surgical team interdisciplinary	When a surgical team approach is used for complex CPB cannulation cases
`78`	Unplanned return to OR	When the patient returns to the OR intra- or postoperatively for issues related to cannulation or CPB management
`80`	Assistant surgeon	When an assistant surgeon participates and is eligible for payment
`81`	Minimum assistant surgeon	When a minimal assistant role is documented
`82`	Assistant surgeon (when qualified resident not available)	When a qualified resident is not available and an assistant is required
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	When an advanced practice clinician performs reportable portions under appropriate state law and payer rules

Taxonomy Code	Specialty	Notes
207K00000X	Cardiothoracic Surgery	Primary surgical specialty performing TAVR with CPB cannulation in complex cases
207RC0000X	Interventional Cardiology	May be primary for TAVR valve deployment; coordinates with CPB team
207L00000X	Vascular Surgery	Performs peripheral open arterial and venous cannulation and vessel repair
207M00000X	Thoracic Surgery	Performs complex thoracic access and assists in conversion to open procedures
363L00000X	Perfusionist	Clinical perfusion specialist responsible for CPB management (non-MD taxonomy)

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I35.0`	Nonrheumatic aortic (valve) stenosis	Primary indication for TAVR/TAVI in most older adults undergoing valve replacement with possible need for CPB support
`I35.1`	Nonrheumatic aortic (valve) insufficiency	Aortic regurgitation cases that may require valve intervention and hemodynamic support
`I06.0`	Rheumatic aortic stenosis	Less common in TAVR patients but a potential surgical indication for valve intervention
`I08.0`	Rheumatic tricuspid stenosis with rheumatic aortic stenosis	Combined valvular disease scenarios that may complicate TAVR and prompt CPB readiness
`I97.1`	Complications following cardiac surgery	Postoperative complications that may necessitate CPB during reintervention or emergent conversion

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Aortic valve, replacement, with cardiopulmonary bypass	Surgical aortic valve replacement option; represents an open alternative if TAVR fails or conversion is required
`33361`	Transcatheter aortic valve replacement (TAVR), percutaneous femoral artery; initial valve	Primary TAVR code for valve implantation that may be performed in same episode when CPB is used as adjunct
`33945`	Cardiopulmonary bypass, initiation of bypass or establishment of CPB circuit (peripheral/cannulation)	Codes CPB circuit initiation and management; used in conjunction with valve procedures when perfusion is required
`32999`	Unlisted procedure, heart or pericardium	May be used for atypical or novel cannulation approaches not described by existing CPT codes (billed with documentation)
`37619`	Repair of femoral artery — including exposure for cannulation	Vascular exposure and repair of femoral access sites commonly performed for open peripheral cannulation required for CPB

CPT 33361: Transcatheter Aortic Valve Replacement, Percutaneous Femoral Approach

CPT-33362-TRANSCATHETER-AORTIC-VALVE-REPLACEMENT-OPEN-FEMORAL-APPROACH

CPT 33362: Transcatheter Aortic Valve Replacement via Open Femoral Artery

CPT-33363-TAVR-TAVI-OPEN-AXILLARY-ARTERY-APPROACH

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

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

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

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

CPT 33365: Transaortic Transcatheter Aortic Valve Replacement (TAVR)

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

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

CPT-33367-CPB-DURING-TRANSCATHETER-AORTIC-VALVE-REPLACEMENT

CPT 33367: Cardiopulmonary Bypass During Primary TAVI/TAVR

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

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

CPT-33370-CEREBRAL-EMBOLIC-PROTECTION-TAVR

CPT 33370: Cerebral Embolic Protection During TAVR

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

CPT 33390: Open Aortic Valve Repair with Cardiopulmonary Bypass

Showing 1–10 of 23

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Standard reporting when no other modifier applies
`11`	Duplicate of service by same physician	When service is a repeat procedural report by the same physician in error — rarely used for operative CPTs
`22`	Increased procedural services	When work, time, or complexity is significantly greater than usual for the CPB cannulation portion
`52`	Reduced services	When CPB cannulation is attempted but not fully completed or service is partially reduced
`53`	Discontinued procedure	When CPB setup is begun but procedure is terminated for patient safety before completion
`62`	Two surgeons	When two surgeons work together as primary surgeons for the CPB cannulation or conversion to open surgery
`63`	Procedure performed on infants/neonates	Use only when patient age qualifies — uncommon for this adult TAVR-related code
`66`	Surgical team interdisciplinary	When a surgical team approach is used for complex CPB cannulation cases
`78`	Unplanned return to OR	When the patient returns to the OR intra- or postoperatively for issues related to cannulation or CPB management
`80`	Assistant surgeon	When an assistant surgeon participates and is eligible for payment
`81`	Minimum assistant surgeon	When a minimal assistant role is documented
`82`	Assistant surgeon (when qualified resident not available)	When a qualified resident is not available and an assistant is required
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	When an advanced practice clinician performs reportable portions under appropriate state law and payer rules

Taxonomy Code	Specialty	Notes
207K00000X	Cardiothoracic Surgery	Primary surgical specialty performing TAVR with CPB cannulation in complex cases
207RC0000X	Interventional Cardiology	May be primary for TAVR valve deployment; coordinates with CPB team
207L00000X	Vascular Surgery	Performs peripheral open arterial and venous cannulation and vessel repair
207M00000X	Thoracic Surgery	Performs complex thoracic access and assists in conversion to open procedures
363L00000X	Perfusionist	Clinical perfusion specialist responsible for CPB management (non-MD taxonomy)

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I35.0`	Nonrheumatic aortic (valve) stenosis	Primary indication for TAVR/TAVI in most older adults undergoing valve replacement with possible need for CPB support
`I35.1`	Nonrheumatic aortic (valve) insufficiency	Aortic regurgitation cases that may require valve intervention and hemodynamic support
`I06.0`	Rheumatic aortic stenosis	Less common in TAVR patients but a potential surgical indication for valve intervention
`I08.0`	Rheumatic tricuspid stenosis with rheumatic aortic stenosis	Combined valvular disease scenarios that may complicate TAVR and prompt CPB readiness
`I97.1`	Complications following cardiac surgery	Postoperative complications that may necessitate CPB during reintervention or emergent conversion

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Aortic valve, replacement, with cardiopulmonary bypass	Surgical aortic valve replacement option; represents an open alternative if TAVR fails or conversion is required
`33361`	Transcatheter aortic valve replacement (TAVR), percutaneous femoral artery; initial valve	Primary TAVR code for valve implantation that may be performed in same episode when CPB is used as adjunct
`33945`	Cardiopulmonary bypass, initiation of bypass or establishment of CPB circuit (peripheral/cannulation)	Codes CPB circuit initiation and management; used in conjunction with valve procedures when perfusion is required
`32999`	Unlisted procedure, heart or pericardium	May be used for atypical or novel cannulation approaches not described by existing CPT codes (billed with documentation)
`37619`	Repair of femoral artery — including exposure for cannulation	Vascular exposure and repair of femoral access sites commonly performed for open peripheral cannulation required for CPB

CPT 33361: Transcatheter Aortic Valve Replacement, Percutaneous Femoral Approach

CPT-33362-TRANSCATHETER-AORTIC-VALVE-REPLACEMENT-OPEN-FEMORAL-APPROACH

CPT 33362: Transcatheter Aortic Valve Replacement via Open Femoral Artery

CPT-33363-TAVR-TAVI-OPEN-AXILLARY-ARTERY-APPROACH

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

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

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

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

CPT 33365: Transaortic Transcatheter Aortic Valve Replacement (TAVR)

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

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

CPT-33367-CPB-DURING-TRANSCATHETER-AORTIC-VALVE-REPLACEMENT

CPT 33367: Cardiopulmonary Bypass During Primary TAVI/TAVR

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

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

CPT-33370-CEREBRAL-EMBOLIC-PROTECTION-TAVR

CPT 33370: Cerebral Embolic Protection During TAVR

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

CPT 33390: Open Aortic Valve Repair with Cardiopulmonary Bypass

Showing 1–10 of 23

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 33368: Cardiopulmonary Bypass During Primary TAVI/TAVR

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Billing Code Overview

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CPT 33368: Cardiopulmonary Bypass During Primary TAVI/TAVR

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References