Summary & Overview
CPT 33460: Tricuspid Valvectomy (Excision of Tricuspid Valve)
CPT code 33460 represents a tricuspid valvectomy — the surgical excision of the tricuspid valve often indicated for severe tricuspid regurgitation, frequently associated with infective endocarditis and valve vegetations. As a high-acuity cardiac surgical procedure, it has implications for inpatient surgical capacity, perioperative management, and reimbursement categorization at a national level.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national benchmarks for utilization and reimbursement frameworks, an overview of clinical indications and coding context, and policy-relevant considerations that affect coverage and billing for complex cardiac surgery. The publication summarizes how CPT code 33460 is positioned relative to related valve procedures and what billing teams and hospital administrators need to track for payer submission and audit readiness.
The report provides clinical context around indications and typical care settings, practical coding notes where available, and summaries of payer contract and coverage patterns. Data not available in the input is explicitly flagged where applicable.
Billing Code Overview
CPT code 33460 describes a valvectomy (excision of the tricuspid valve) performed to treat significant tricuspid regurgitation, commonly due to vegetations from infective endocarditis. The procedure involves surgical removal of the native tricuspid valve tissue.
Service type: Surgical — cardiac valve surgery
Typical site of service: Inpatient hospital — operating room with postoperative inpatient care
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents with fever, new onset murmur, and positive blood cultures for Staphylococcus aureus. Echocardiography demonstrates large mobile vegetations on the tricuspid valve with severe tricuspid regurgitation and recurrent septic pulmonary emboli despite targeted intravenous antibiotics. After multidisciplinary review, the cardiothoracic surgery team schedules operative management. In the operating room under general anesthesia, the surgeon performs a tricuspid valvectomy (CPT 33460) with excision of the infected valve tissue. The intraoperative workflow includes median sternotomy, cardiopulmonary bypass, inspection of the right-sided structures, excision of the tricuspid valve leaflets and infected tissue, assessment for concomitant procedures, and placement of temporary measures (e.g., right atrial repair or patching) as indicated. Postoperative care involves intensive care monitoring, continued intravenous antimicrobial therapy guided by infectious disease, serial echocardiography, and planning for possible delayed valve replacement if hemodynamics and infection control allow.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and complexity substantially exceed typical for 33460 due to extensive debridement or complex anatomy |