Summary & Overview
CPT 33430: Mitral Valve Replacement with Cardiopulmonary Bypass
Headline: New overview of CPT 33430 — Mitral valve replacement with cardiopulmonary bypass
Lead: CPT 33430 codes for surgical replacement of the mitral valve performed with cardiopulmonary bypass, a high-acuity inpatient cardiovascular procedure with significant clinical and billing implications nationwide. This code is central to reimbursement and case-mix considerations for hospitals and cardiothoracic surgery programs.
What the code represents and why it matters: CPT 33430 denotes definitive surgical management for severe mitral valve disease when repair is not appropriate. As an inpatient, operating-room–based procedure, it drives resource use, length of stay, and quality reporting metrics. Accurate coding affects hospital reimbursement, quality measurement, and downstream care coordination for complex cardiac patients.
Key payers covered: This overview addresses coverage and billing considerations relevant to Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication summarizes clinical context for use of CPT 33430, contrasts it with related mitral and other valve procedures, outlines common billing themes such as procedural complexity and typical inpatient setting, and highlights where coding clarity is important for payers and providers. It also identifies areas where input data was not provided. Specific benchmarking, payer policy language, and line-item service metadata are covered in subsequent sections.
Data limitations: Data not available in the input for specific service-line metadata and payer-specific policy text.
CPT Code Overview
CPT 33430 describes replacement of the mitral valve performed with cardiopulmonary bypass. This procedure is a form of cardiothoracic surgery addressing diseased or dysfunctional mitral valves through excision and prosthetic valve implantation while the patient is supported by cardiopulmonary bypass.
Service Type: Cardiovascular / Cardiothoracic Surgery
Typical Site of Service: Hospital Inpatient (POS 21)
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with progressive mitral valve disease presents with severe symptomatic mitral regurgitation and/or mitral valve stenosis refractory to medical therapy. Preoperative workup includes transthoracic and transesophageal echocardiography demonstrating dysfunctional mitral leaflets with significant hemodynamic compromise, cardiac catheterization to assess coronary anatomy, and multidisciplinary evaluation by cardiology and cardiothoracic surgery. The patient is admitted to the hospital (inpatient) for planned mitral valve replacement under general anesthesia with cardiopulmonary bypass. Intraoperative workflow includes median sternotomy, institution of cardiopulmonary bypass, removal of the native mitral valve, implantation of a prosthetic valve, intraoperative transesophageal echocardiography confirmation of valve function, weaning from bypass, and transfer to the cardiac intensive care unit for postoperative monitoring and recovery.
Coding Specifications
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Modifier
22- Increased Procedural ServicesUse when the work required to perform
33430is substantially greater than typically required. Documentation must support the increased complexity, time, difficulty, or risk. -
Modifier
51- Multiple ProceduresUse when
33430is performed in conjunction with other distinct surgical procedures during the same operative session. Append modifier51according to payer rules when reporting multiple procedure reductions or bundling policies apply.