Summary & Overview
CPT 33411: Aortic Valve Replacement with Annulus Enlargement
CPT code 33411 denotes an open surgical aortic valve replacement with enlargement of the aortic annulus to allow placement of a larger prosthetic valve. This procedure is performed to treat symptomatic aortic stenosis or aortic regurgitation and is a critical option when annular size would otherwise limit prosthesis selection. Nationally, aortic valve replacement procedures drive significant inpatient surgical volumes and resource use, with implications for hospital cardiac surgery programs and payer coverage policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 33411, typical sites of service, and the relevance of annular enlargement to prosthetic valve selection. The publication provides benchmarking context where available, summarizes common billing modifiers and coding considerations, and outlines clinical indications tied to the procedure description. Data gaps are noted as "Data not available in the input." This summary is intended to inform coding, billing, and policy stakeholders about the clinical procedure represented by CPT code 33411 and the elements that commonly affect claims and utilization on a national level.
Billing Code Overview
CPT code 33411 describes an aortic valve replacement with enlargement of the aortic annulus to permit insertion of a larger prosthetic valve. The procedure involves replacement of a diseased native aortic valve with an artificial valve and surgical enlargement of the aortic annulus when necessary to accommodate a larger prosthesis.
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Service type: Cardiac surgery—open surgical aortic valve replacement with annular enlargement
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Typical site of service: Inpatient hospital operating room, often followed by inpatient postoperative care
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old male with symptomatic severe aortic stenosis presenting with exertional dyspnea, angina, and syncope. Diagnostic workup includes transthoracic echocardiography demonstrating a calcified, stenotic aortic valve with a mean gradient >40 mmHg and valve area <1.0 cm2, and coronary angiography ruling out prohibitive coronary disease. The patient is scheduled for surgical aortic valve replacement with annular enlargement to permit implantation of a larger prosthetic valve (CPT 33411). The clinical workflow begins with preoperative evaluation (history, physical, labs, cross-match, anesthesia assessment), perioperative transesophageal echocardiography to guide valve sizing and confirm function, cardiopulmonary bypass and aortic cross-clamping, performance of an aortic root/annular enlargement (such as Konno or Nicks-type enlargement) followed by insertion and securement of a mechanical or bioprosthetic valve, intraoperative assessment of valve competence, and postoperative intensive care monitoring for hemodynamics, bleeding, and arrhythmia management. Typical site of service is an inpatient operating room with postoperative care in a cardiac surgical intensive care unit. Service type is open surgical aortic valve replacement with annular enlargement for treatment of aortic valve stenosis or regurgitation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons |