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    v1.0.28
    OpenPayerBilling CodesSurgical Procedures on the Aortic ValveCPT cpt-33414-left-ventricular-outflow-tract-patch-enlargement
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    CPT 33414: Repair of Left Ventricular Outflow Tract with Patch

    Medicare pays $2003 on average nationally for this procedure.

    CPT code 33414 describes surgical repair of a left ventricular outflow tract obstruction using a patch to enlarge the outflow tract; this is a cardiac surgical procedure (open heart) performed in an operating room or cardiac surgery suite for patients with obstructive left ventricular outflow physiology.

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 45–65-year-old adult with symptomatic left ventricular outflow tract (LVOT) obstruction due to hypertrophic cardiomyopathy or subaortic membrane causing exertional dyspnea, syncope, or angina. The patient has preoperative evaluation including transthoracic and transesophageal echocardiography confirming dynamic or fixed LVOT obstruction and gradients warranting surgical intervention. Cardiac catheterization may be performed to evaluate coronary anatomy. The procedure, patch enlargement of the LVOT, is scheduled in an operating room with cardiopulmonary bypass capability under general endotracheal anesthesia. Intraoperative transesophageal echocardiography is used to guide repair and confirm relief of obstruction. Postoperatively the patient is admitted to a cardiac surgical intensive care unit for hemodynamic monitoring, ventilatory weaning, rhythm surveillance, and anticoagulation management as clinically indicated. Typical workflow includes pre-op history and physical, informed consent, preoperative labs and imaging, intraoperative corrective patch placement to widen the LVOT, immediate intraoperative assessment of gradient reduction, and staged postoperative rehabilitation and follow-up imaging to document durable relief.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    33405Repair of ventricular septal defect with or without patch (intracardiac)May be performed concurrently if VSD is present and accessed during LVOT patch enlargement.
    93451Right heart catheterization including intraprocedural hemodynamic measurements (cardiac catheterization codes are by cardiology)Diagnostic catheterization performed preoperatively to assess hemodynamics and coronary anatomy prior to open repair.
    93312Echocardiography transesophageal, intraoperativeIntraoperative TEE used to guide repair and confirm reduction in LVOT gradient.
    33418Reconstruction of LVOT with prosthetic or other material (adjunctive procedures)Related open procedures that may be performed for LVOT reconstruction; may be reported when distinct from primary code depending on documentation and coding guidelines.
    99223Initial hospital care, typically 70 minutes or moreExample of inpatient evaluation and management code used for complex postoperative care (provider documentation-driven).

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    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…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    246ZG1000XMedical Geneticist (PhD) Specialist/TechnologistTechnologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Other
    1223D0004XDental AnesthesiologyA dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years durati…
    171W00000XContractorFor the purposes of the Health Care Provider Taxonomy, a contractor is limited to individuals who do construction or mechanical work to modify a patie…
    333300000XEmergency Response System CompaniesA supplier of a personal emergency response system (PERS), which is an electronic device that enables a patient to receive emergency assistance when n…
    332H00000XEyewear SupplierAn organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
    225XL0004XLow Vision Occupational TherapistOccupational therapists enable children and adults with visual impairment to engage in their chosen daily living activities safely and as independentl…
    2086X0206XSurgical Oncology PhysicianA surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevent…
    163WX0200XOncology Registered NurseNursing Service Providers · Registered Nurse

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    I06.0Rheumatic aortic stenosis
    I06.2Rheumatic aortic stenosis with insufficiency
    I08.0Rheumatic disorders of both mitral and aortic valves
    I08.1Rheumatic disorders of both mitral and tricuspid valves
    I08.9Rheumatic multiple valve disease, unspecified
    I34.0Nonrheumatic mitral (valve) insufficiency
    I34.9Nonrheumatic mitral valve disorder, unspecified
    I35.0Nonrheumatic aortic (valve) stenosis
    I35.1Nonrheumatic aortic (valve) insufficiency
    I42.0Dilated cardiomyopathy

    Showing 1–10 of 27

    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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