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CPT 33430: Mitral Valve Replacement Surgery
Headline: CPT code 33430: Mitral Valve Replacement for Severe Mitral Valve Disease
Lead: CPT code 33430 represents surgical replacement of the mitral valve and is a key inpatient cardiothoracic procedure used when valve repair is not feasible for disorders such as mitral stenosis or mitral regurgitation. The code captures a complex, resource-intensive intervention with significant implications for clinical outcomes and hospital resource use.
CPT code 33430 denotes mitral valve replacement and matters nationally due to the procedure’s impact on perioperative resources, long-term anticoagulation needs, and cardiovascular morbidity. This code is central to billing for definitive surgical management of advanced mitral valve disease.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise summary of the clinical context for mitral valve replacement, typical site of service, and the relationship of this code to adjacent mitral valve repair and other valve procedures. The publication outlines benchmarks and payment policy considerations, clarifies coding relationships to related mitral procedures, and provides context for payer coverage patterns and claim review triggers. The content is intended for clinicians, coding staff, and policy analysts seeking a national perspective on coding and clinical use of CPT code 33430.
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Billing Code Overview
CPT code 33430 describes replacement of the mitral valve of the heart, performed when repair is not feasible for conditions such as mitral stenosis or mitral regurgitation. The procedure involves removing the diseased native valve and implanting a prosthetic valve to restore unidirectional blood flow from the left atrium to the left ventricle.
Service type: Surgical — cardiac valve replacement (mitral valve)
Typical site of service: Inpatient hospital setting, generally in an operating room with cardiothoracic surgical capability and cardiopulmonary bypass support.
National Reimbursement Benchmarks
Medicare’s mean national rate of $2635.20 sits below BUCA’s average commercial mean of $3455.30, indicating BUCA reimburses substantially higher on average for CPT 33430 than Medicare. The difference between BUCA and Medicare means is $820.10, placing Medicare nearer to the lower-middle of the national commercial spectrum while BUCA is closer to higher commercial averages.
Dispersion (P75–P25) highlights variability across payers: Blue Cross Blue Shield’s interquartile spread is $1,887.50, UnitedHealth Group’s is $3,125.90, Cigna’s is $2,987.80, Aetna’s is $2,634.00, and BUCA’s is $2,401.70. UnitedHealth Group therefore exhibits the widest IQR and the greatest middle-range variability, while Blue Cross Blue Shield is the tightest among those with available quartiles, indicating relatively more concentrated commercial pricing in that payer’s middle 50%.