CPT 33414 LVOT Patch Enlargement Reimbursement | OpenPayer

Summary & Overview

CPT 33414: Left Ventricular Outflow Tract Patch Enlargement

CPT code 33414 represents a cardiac surgical repair performed to relieve left ventricular outflow tract obstruction through patch enlargement of the outflow tract. This procedure is significant nationally because it addresses obstructive physiology that can cause heart failure symptoms, impaired exercise capacity, and increased surgical risk if left untreated. As a specialized open cardiac intervention, it has implications for hospital resource use, perioperative management, and coding precision for cardiac surgery programs.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for CPT code 33414, typical sites of care, and the common payer landscape relevant to reimbursement and prior authorization workflows. The publication outlines expected billing considerations, common modifiers in circulation, and related service-line implications. It also highlights benchmarks and policy updates where available and clarifies which data elements are not provided in the input.

This summary is intended for clinical coders, revenue cycle managers, and policy analysts seeking a national overview of the code’s clinical meaning, payer coverage context, and the types of operational and policy topics to review when this code appears on a claim.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 33414cardiac surgeryleft ventricular outflow tractLVOT repairpatch enlargementinpatient surgerycardiothoracicsurgical procedureprocedure coding

Billing Code Overview

CPT code 33414 describes a surgical procedure to relieve left ventricular outflow tract obstruction by enlarging the outflow tract with a patch repair. This is a cardiac surgical intervention aimed at improving blood flow from the left ventricle into the aorta by enlarging the narrowed tract.

Service Type: Cardiac surgical procedure — left ventricular outflow tract enlargement with patch

Typical Site of Service: Inpatient hospital operating room (cardiac surgery)

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.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier / default	Rarely appended; code reported without additional modifier when no special circumstances apply.

CPT 33390: Open Aortic Valve Repair with Cardiopulmonary Bypass

CPT-33412-AORTIC-VALVE-REPLACEMENT-ANNULAR-ENLARGEMENT-KONNO

CPT 33412: Aortic Valve Replacement with Annular Enlargement or Konno Procedure

CPT-33405-AORTIC-VALVE-REPLACEMENT-OPEN-BYPASS

CPT 33405: Aortic Valve Replacement, Open with Cardiopulmonary Bypass

CPT-33391-AORTIC-VALVE-RECONSTRUCTION-OPEN-CPB

CPT 33391: Aortic Valve Reconstruction, Open with Cardiopulmonary Bypass

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

CPT 33368: Cardiopulmonary Bypass During Primary TAVI/TAVR

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

CPT 33361: Transcatheter Aortic Valve Replacement, Percutaneous Femoral Approach

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

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

CPT-33370-CEREBRAL-EMBOLIC-PROTECTION-TAVR

CPT 33370: Cerebral Embolic Protection During TAVR

CPT-33406-AORTIC-VALVE-REPLACEMENT-ALLOGRAFT-OPEN-SURGERY

CPT 33406: Aortic Valve Replacement with Allograft, Open Surgical Approach

CPT-33404-APICOAORTIC-CONDUIT-AORTIC-VALVE-BYPASS

CPT 33404: Apicoaortic Conduit (Aortic Valve Bypass)

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Taxonomy Code	Specialty	Notes
Data not available in the input.	Cardiothoracic Surgery	Cardiothoracic surgeons commonly perform LVOT patch enlargement for obstructive lesions.
Data not available in the input.	Pediatric Cardiac Surgery	Pediatric cardiac surgeons perform similar repairs in congenital LVOT obstruction in younger patients.
Data not available in the input.	Cardiac Surgery (Adult)	Adult cardiac surgeons manage acquired and congenital LVOT obstructive pathology.
Data not available in the input.	Cardiovascular Surgery	Cardiovascular surgeons with subspecialty training also perform complex LVOT reconstructions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I42.1`	Hypertrophic cardiomyopathy	Common cause of dynamic LVOT obstruction treated by surgical enlargement.
`I35.1`	Nonrheumatic aortic (valve) stenosis with heart failure	Severe valvular obstruction can coexist with LVOT obstruction and affect surgical planning.
`I06.0`	Rheumatic aortic stenosis	May produce LVOT or subvalvular obstruction requiring corrective surgery in select cases.
`Q24.0`	Ventricular septal defect	Congenital lesions that may be associated with subaortic obstruction requiring patch repair.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Coronary disease often assessed preoperatively; concomitant CABG may be planned.
`R07.9`	Chest pain, unspecified	Symptom prompting diagnostic evaluation leading to identification of LVOT obstruction.
`I50.9`	Heart failure, unspecified	Patients with symptomatic LVOT obstruction may present with heart failure symptoms influencing perioperative care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Repair of ventricular septal defect with or without patch (intracardiac)	May be performed concurrently if VSD is present and accessed during LVOT patch enlargement.
`93451`	Right 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.
`93312`	Echocardiography transesophageal, intraoperative	Intraoperative TEE used to guide repair and confirm reduction in LVOT gradient.
`33418`	Reconstruction 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.
`99223`	Initial hospital care, typically 70 minutes or more	Example of inpatient evaluation and management code used for complex postoperative care (provider documentation-driven).

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