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CPT 33426: Mitral Valvuloplasty (Mitral Valve Repair)
CPT code 33426 represents a mitral valvuloplasty — a surgical repair of the mitral valve to correct valve closure and prevent regurgitation from the left ventricle to the left atrium. This procedure is clinically significant because mitral valve repair preserves native valve tissue, can improve cardiac function, and may reduce long-term morbidity compared with valve replacement in appropriate patients. The code applies to open surgical mitral valve repair performed by cardiothoracic or cardiovascular surgeons, typically in an inpatient hospital operating room with perioperative cardiopulmonary support.
Key payers included in this national overview are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise review of the clinical context for use of CPT code 33426, common relevant diagnoses that justify the procedure, adjacent surgical codes for related valve procedures, and typical billing considerations. The publication highlights how the code fits within surgical service lines such as thoracic and cardiovascular surgery and notes associated diagnosis categories like mitral insufficiency, prolapse, and stenosis. It also outlines which related CPT codes are commonly reported alongside or as alternatives to 33426 for mitral valve procedures.
This summary serves clinicians, coding professionals, and policy analysts seeking a national-level reference for the clinical meaning, service setting, and payer coverage landscape surrounding CPT code 33426.
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Billing Code Overview
CPT code 33426 describes a mitral valvuloplasty procedure performed to repair the mitral valve so it closes properly and prevents backflow of blood from the left ventricle to the left atrium. The procedure is a surgical valve repair intended to restore valve function rather than replace the valve.
Service type: Cardiac surgical valve repair (mitral valvuloplasty)
Typical site of service: Inpatient hospital operating room or cardiac surgery suite, performed by cardiothoracic or cardiovascular surgeons with appropriate perioperative and intensive care support.
National Reimbursement Benchmarks
Average commercial reimbursement for CPT 33426 varies notably from Medicare. Medicare’s mean is $2,242.30 while BUCA’s mean (as a stand‑in for an average commercial group) is $2,965.70, so BUCA pays about $723.40 more on average than Medicare. That gap highlights higher commercial pricing for this procedure versus the federal program even though some commercial payers exceed BUCA’s mean by large margins.
Dispersion measured by the interquartile range (P75−P25) is widest for UnitedHealth Group at $2,634.60 (P75 $5,317.00 minus P25 $2,682.40) and Cigna is also wide at $2,492.60 (P75 $4,925.60 minus P25 $2,433.00). Blue Cross Blue Shield shows a moderate spread of $1,646.90, while Aetna is tighter at $1,226.90. BUCA’s IQR is $2,049.10 and Medicare’s IQR is $175.00, making Medicare the tightest and UnitedHealth Group the most dispersed payers in this set.