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    v1.0.28
    OpenPayerBilling CodesSurgical Procedures on the Aortic ValveCPT cpt-33412-aortic-valve-replacement-annular-enlargement-konno
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    CPT 33412: Aortic Valve Replacement with Annular Enlargement

    Medicare pays $2945 on average nationally for this procedure.

    CPT code 33412 describes surgical aortic valve replacement with enlargement of the aortic annulus to permit insertion of a larger prosthetic valve, including the Konno procedure for congenital aortic stenosis; this is a cardiac surgical service performed in an operating room or cardiac surgery suite (inpatient or selected outpatient hospital settings) and involves replacement of the native aortic valve with an artificial prosthesis to treat aortic valve stenosis or regurgitation.

    For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 62-year-old male with progressive exertional dyspnea, angina, and syncope found to have severe aortic stenosis on echocardiography with mean gradient >40 mmHg and an aortic valve area <1.0 cm2. Coronary angiography shows no prohibitive coronary disease. After multidisciplinary heart team review, the patient is scheduled for surgical aortic valve replacement (SAVR) with annular enlargement (Konno or other aortic root enlargement technique) to permit insertion of a larger prosthetic valve and reduce patient–prosthesis mismatch. The clinical workflow includes preoperative evaluation (history and physical, transthoracic echo, transesophageal echo as indicated, cardiac catheterization, labs, and anesthesia assessment), intraoperative general endotracheal anesthesia with median sternotomy, cardiopulmonary bypass, aortic valve excision, annular enlargement and placement of a mechanical or bioprosthetic valve, and postoperative care in the cardiac surgical ICU with hemodynamic monitoring, anticoagulation management if mechanical valve implanted, and planned discharge once stable. Typical site of service is an inpatient acute care hospital operating room with postoperative stay in an intensive care unit.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    33405Replacement, aortic valve, with cardiopulmonary bypass; with tissue graft (bioprosthesis)Alternative code when a surgical aortic valve replacement is performed without annular enlargement; may be used if no enlargement performed.
    33430Replacement, aortic valve, with cardiopulmonary bypass; with cardiopulmonary bypass, mechanical valveUsed when a mechanical prosthesis is implanted during SAVR; commonly documented alongside 33412 if annular enlargement also performed (report per coding rules).
    33967Implantation of intracardiac mechanical circulatory support device (ventricular assist device), non-biventricularOccasionally performed in complex cases where ventricular support is required in addition to valve surgery.
    93505Catheterization of a coronary artery with diagnostic injection; single major coronary arteryUsed in the preoperative workup for coronary anatomic assessment before valve surgery.
    93306Echocardiography, transthoracic, real-time with image documentation, completePreoperative and postoperative transthoracic echocardiography to assess valve function and ventricular performance.
    92920Cardiopulmonary resuscitation (external cardiac massage)Emergency code sometimes reported if intraoperative or postoperative cardiac arrest occurs during the surgical episode.

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    2086H0002XHospice and Palliative Medicine (Surgery) PhysicianA surgeon with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist…
    341600000XAmbulanceAn emergency vehicle used for transporting patients to a health care facility after injury or illness. Types of ambulances used in the United States i…
    251X00000XSupports Brokerage AgencyA provider of service/function that assists participating individuals to make informed decisions about what will work best for them is consistent with…
    2085H0002XHospice and Palliative Medicine (Radiology) PhysicianA radiologist with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specia…
    207RA0000XAdolescent Medicine (Internal Medicine) PhysicianAn internist who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and so…

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21
    Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_BlocksCigna2026-05-15
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01

    Related Codes

    CPT-33361-TRANSCATHETER-AORTIC-VALVE-REPLACEMENT-FEMORAL

    CPT 33361: Transfemoral Transcatheter Aortic Valve Implantation (TAVR)

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

    CPT 33362: Transcatheter Aortic Valve Replacement, Open Femoral Artery Approach

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

    CPT 33363: Transcatheter Aortic Valve Replacement, Open Axillary Approach

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

    CPT 33364: Transcatheter Aortic Valve Replacement, Open Iliac Approach

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

    CPT 33365: Transaortic Transcatheter Aortic Valve Replacement

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

    CPT 33366: Transapical Transcatheter Aortic Valve Replacement

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

    CPT 33367: Cardiopulmonary Bypass for Percutaneous Cannulation in TAVI/TAVR

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

    CPT 33368: Cardiopulmonary Bypass for TAVI/TAVR with Open Peripheral Cannulation

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

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

    CPT-33370-CEREBRAL-EMBOLIC-PROTECTION-TAVR

    CPT 33370: Cerebral Embolic Protection Placement During TAVR

    Showing 1–10 of 23

    Frequently Asked Questions

    References

    1. 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. 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. 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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