Summary & Overview
CPT 33465: Tricuspid Valve Replacement on Cardiopulmonary Bypass
CPT code 33465 designates open surgical replacement of the tricuspid valve performed with the patient on cardiopulmonary bypass. This code captures a major cardiac surgical intervention for severe tricuspid valve disease, including regurgitation or stenosis not amenable to repair. Nationally, tricuspid valve replacement represents a focused but clinically significant portion of cardiac surgical volume due to its complexity, resource intensity, and implications for perioperative care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context, typical site-of-service considerations, and the elements that define billing for an open tricuspid valve replacement. The publication also summarizes common billing modifiers and payer coverage patterns where available, alongside coding neighbors and service-line placement to assist revenue cycle and clinical teams in mapping procedures to inpatient surgical workflows.
This overview is intended for national audiences involved in coding, clinical operations, and payer contracting. It explains what the code represents, where the service is usually delivered, and what operational and policy topics are most relevant for teams managing high-acuity cardiac surgery cases.
Billing Code Overview
CPT code 33465 describes the surgical replacement of the tricuspid valve while the patient is supported on cardiopulmonary bypass. The tricuspid valve separates the right atrium and right ventricle and consists of three leaflets; replacement entails removal of the native valve and implantation of a prosthetic device.
Service type: Invasive cardiac surgical procedure — valve replacement on cardiopulmonary bypass
Typical site of service: Hospital inpatient operating room, often performed by cardiothoracic surgeons in facilities equipped for open-heart surgery and cardiopulmonary bypass.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old with symptomatic severe tricuspid valve disease (eg, severe tricuspid regurgitation causing right-sided heart failure with peripheral edema, hepatic congestion, and exertional dyspnea) referred for surgical valve replacement. Preoperative evaluation includes transthoracic and transesophageal echocardiography confirming leaflet pathology or annular dilation, right heart catheterization as indicated, optimization of volume status, and review of comorbidities such as coronary artery disease or pulmonary hypertension. The procedure 33465 is performed in an operating room or cardiac surgical suite with the patient on cardiopulmonary bypass under general anesthesia. Typical intraoperative workflow includes median sternotomy (or alternative approach), institution of cardiopulmonary bypass, excision of the native tricuspid valve leaflets, placement of a prosthetic valve (mechanical or bioprosthetic), testing of valve competence, weaning from bypass, hemostasis, and closure. Postoperative care occurs in the cardiac intensive care unit with hemodynamic monitoring, anticoagulation management if a mechanical valve is used, and echocardiographic assessment before discharge. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | When two surgeons work together as primary surgeons on the procedure |