CPT 33419 Percutaneous Mitral Repair Reimbursement | OpenPayer

Summary & Overview

CPT 33419: Percutaneous Mitral Valve Repair with Additional Prosthesis Placement

CPT code 33419 represents percutaneous mitral valve repair with placement of additional prosthetic components during the same operative session as an initial mitral valve repair and prosthesis insertion. The code captures complex intraprocedural implantation when a provider releases a stenotic, stiff mitral valve — potentially using transseptal access — while the patient is on cardiopulmonary bypass. Nationally, this code is relevant for assessing utilization and reimbursement of advanced structural heart interventions and for aligning clinical documentation with procedural complexity.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of procedural scope and clinical context, typical sites of service, and the payer mix considered. The publication outlines benchmarks and common coverage considerations for advanced mitral valve interventions, highlights coding and billing implications for same-session additional prosthesis placement, and summarizes policy developments that affect authorization and hospital billing workflows. The content aims to support clinicians, billing professionals, and policy analysts in understanding where CPT code 33419 fits within structural heart procedure coding and payer landscapes. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33419CPTmitral valve repairstructural heartpercutaneous interventioncardiac surgeryprosthesis placementcardiopulmonary bypass

Billing Code Overview

CPT code 33419 describes placement of additional prosthetic components during the same session as an initial mitral valve repair and prosthesis placement. The procedure involves percutaneous techniques to repair a narrowed, stiff mitral valve and may include transseptal puncture of the heart. The valve is released while the patient is supported by cardiopulmonary bypass, and one or more additional prostheses are implanted during the same operative session.

Service type: Percutaneous mitral valve repair with additional prosthesis placement during the same session
Typical site of service: Hospital operating room or cardiac catheterization lab with cardiopulmonary bypass capability

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with symptomatic severe mitral stenosis secondary to calcific degenerative disease presents for percutaneous mitral valve repair with placement of a prosthetic device. The cardiac surgery and interventional cardiology teams coordinate care. Preoperative evaluation includes transthoracic and transesophageal echocardiography to confirm valve anatomy, cardiac catheterization as indicated to assess coronary disease, and routine labs. The patient is brought to a hybrid operating room or cardiac catheterization laboratory under general anesthesia. Vascular access is obtained, transseptal puncture may be performed to reach the mitral valve, and balloon valvuloplasty or leaflet release techniques are applied as needed. If a prosthetic mitral valve device is placed and additional prostheses are required during the same operative session, the surgeon deploys the additional devices while the patient remains on cardiopulmonary bypass when indicated. Postprocedure care includes ICU monitoring, repeat echocardiography to confirm valve function and prosthesis position, anticoagulation management, and discharge planning with cardiology follow-up.

Coding Specifications

Modifier	Description	When to Use
`00`	Emergency service	Use for emergent, life-threatening presentation requiring immediate surgery when payer recognizes `00`.

CPT 33425: Open Mitral Valve Repair with Cardiopulmonary Bypass

CPT-33427-MITRAL-VALVULOPLASTY-CARDIOPULMONARY-BYPASS

CPT 33427: Mitral Valvuloplasty with Cardiopulmonary Bypass

CPT-33430-MITRAL-VALVE-REPLACEMENT-INPATIENT-CARDIAC-SURGERY

CPT 33430: Mitral Valve Replacement Surgery

CPT-33418-PERCUTANEOUS-MITRAL-VALVE-REPAIR-WITH-BYPASS

CPT 33418: Percutaneous Mitral Valve Repair With Bypass

CPT-33420-MITRAL-VALVE-COMMISSUROTOMY-BEATING-HEART

CPT 33420: Mitral Valve Commissurotomy on Beating Heart

CPT-33422-MITRAL-VALVE-REPAIR-OPEN-CARDIAC-SURGERY

CPT 33422: Open Mitral Valve Repair Under Cardiopulmonary Bypass

CPT-33426-MITRAL-VALVULOPLASTY-MITRAL-VALVE-REPAIR

CPT 33426: Mitral Valvuloplasty (Mitral Valve Repair)

Taxonomy Code	Specialty	Notes
330100000X	Cardiothoracic Surgery	Primary specialty that performs open mitral valve repair and prosthesis placement.
207RP0000X	Interventional Cardiology	Performs percutaneous mitral valve interventions including transseptal access and device placement.
207RR0500X	Thoracic and Cardiac Surgery	Cardiac surgical specialty overlapping with cardiothoracic surgery in complex valve cases.
363A00000X	Anesthesiology	Provides general anesthesia and cardiac anesthesia services in the operating room or hybrid suite.
207L00000X	Interventional Cardiology - Structural Heart	Subspecialty focus on structural heart interventions; commonly involved in transcatheter mitral procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I05.0`	Rheumatic mitral stenosis with mitral regurgitation	Rheumatic causes of mitral valve disease that may require percutaneous repair and prosthesis placement.
`I05.9`	Rheumatic mitral valve disease, unspecified	General rheumatic involvement of the mitral valve leading to stenosis or regurgitation addressed by procedure.
`I34.0`	Nonrheumatic mitral (valve) prolapse	Degenerative mitral disease that may progress to dysfunction requiring intervention.
`I34.1`	Nonrheumatic mitral (valve) regurgitation	Common indication when regurgitation is severe and symptomatic, prompting repair or prosthesis.
`I35.0`	Nonrheumatic aortic (valve) stenosis	Included when multivalve disease is present; may affect perioperative planning though not the primary target.
`I39`	Endocarditis and heart valve disorders in diseases classified elsewhere	Infective or inflammatory processes that may necessitate valve repair or replacement.
`I42.0`	Dilated cardiomyopathy	Ventricular dysfunction that impacts procedural risk assessment and postoperative management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33426`	Valvuloplasty, mitral valve, percutaneous, with or without transseptal puncture	Often performed as the primary percutaneous mitral valve intervention; may be an alternative or preceding procedure.
`33430`	Replacement, mitral valve, with cardiopulmonary bypass	Open surgical mitral valve replacement; may be performed if repair with prosthesis is not feasible intraoperatively.
`93458`	Catheter placement in coronary artery and left heart chambers, with left heart angiography including ventriculography when performed; with percutaneous transseptal puncture	Diagnostic/therapeutic catheterization codes that document access and imaging steps used during percutaneous mitral interventions.
`93312`	Echocardiography, transesophageal, real-time with image documentation, including probe placement, adult	Intraoperative TEE used to guide device placement and confirm prosthesis position and function.
`00530`	Anesthesia for cardiac valve procedures involving cardiopulmonary bypass	Anesthesia time-based code commonly reported by anesthesiologists for open mitral valve procedures requiring bypass.

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