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CPT 33475: Pulmonary Valve Replacement

CPT code 33475 represents surgical replacement of the pulmonary valve with a prosthetic valve. This cardiac surgical code is used for adults—frequently those with prior congenital heart defect repairs—who develop pulmonary regurgitation and resultant right ventricular hypertrophy. The procedure is clinically significant because it addresses valve incompetence that can progress to right-sided heart failure and impacts resource use in inpatient cardiac surgery.

Key payers in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is indicated, typical sites of service, and the payer mix used in benchmarking. The publication also summarizes common billing modifiers and related administrative details where available and notes when specific data elements are not provided.

This overview is aimed at clinicians, coding professionals, and policy analysts who need a concise reference to the clinical intent of the code, its role in managing late sequelae of congenital heart disease, and the payer landscape affecting reimbursement and utilization at a national level.

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Billing Code Overview

CPT code 33475 describes a surgical procedure in which the provider removes the native pulmonary valve and replaces it with an artificial (prosthetic) pulmonary valve. This procedure is typically performed to correct pulmonary regurgitation and its sequelae, such as right ventricular hypertrophy, often in adults who previously underwent congenital heart defect repairs as infants.

Service type: Surgical cardiac valve replacement
Typical site of service: Inpatient hospital operating room with postoperative inpatient care

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CPT 33475: Pulmonary Valve Replacement

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Billing Code Overview

Service type: Surgical cardiac valve replacement
Typical site of service: Inpatient hospital operating room with postoperative inpatient care

Clinical & Coding Specifications

Clinical Context

A 42-year-old adult with a history of childhood repair of tetralogy of Fallot presents with progressive exertional dyspnea and recurrent arrhythmia. Echocardiography and cardiac MRI demonstrate severe pulmonary regurgitation with right ventricular enlargement and dysfunction. After multidisciplinary review, the cardiothoracic surgery team schedules a pulmonary valve replacement with a prosthetic valve. The patient is admitted to a tertiary care hospital's cardiothoracic operating suite. Preoperative workflow includes cardiac imaging, laboratory testing, anesthesia evaluation, and informed consent. Intraoperative steps include median sternotomy (or redo sternotomy), cardiopulmonary bypass, excision of the native or dysfunctional pulmonary valve, and implantation of a bioprosthetic or mechanical valve. Postoperative care occurs in the cardiac intensive care unit with hemodynamic monitoring, chest tube management, pain control, anticoagulation planning (if mechanical valve), and physical therapy, followed by discharge planning and outpatient cardiology follow-up.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier required / general clinical reporting	Not commonly appended; represents default reporting when no modifier applies
`11`	Primary procedure	Use when this pulmonary valve replacement is the primary reason for the encounter
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical expectations (document justification)
`23`	Unusual anesthesia	Use when general anesthesia is contraindicated and significantly different anesthesia techniques are used
`50`	Bilateral procedure	Not typically used for single-valve replacement; not applicable unless coding paired procedures
`51`	Multiple procedures	Use when additional distinct surgical procedures are performed in the same operative session
`52`	Reduced services	Use if the procedure is partially reduced or not completed as originally planned
`53`	Discontinued procedure	Use if the operation is started but aborted for patient safety reasons before completion
`62`	Two surgeons	Use when two surgeons work together as primary surgeons of record (co-surgeons) during the valve replacement
`63`	Procedure performed on infants younger than 4 kg	Generally not applicable to adult cases; applicable when patient meets weight criteria
`78`	Return to operating room for related procedure during postoperative period	Use when a related procedure is performed during the global period due to complications (e.g., hemorrhage)
`80`	Assistant surgeon	Use when an assistant surgeon provides surgical assistance during the valve replacement
`81`	Minimum assistant surgeon	Use when minimal assistance is provided (document level of assistance)
`AS`	Physician assistant, nurse practitioner, clinical nurse specialist services	Use when an advanced practice clinician performs or assists and services are billed per payer rules

Taxonomy Code	Specialty	Notes
207L00000X	Thoracic Surgery	Primary specialty for surgical pulmonary valve replacement
207P00000X	Cardiovascular Surgery	Common specialty for adult congenital and valve operations
2086S0122X	Cardiac Surgery	Focused cardiac surgical practice performing valve replacements
207RG0300X	Pediatric Cardiothoracic Surgery	In centers treating adult congenital heart disease, pediatric surgical expertise may be involved
208000000X	Cardiovascular Disease (Cardiology)	Cardiology provides preoperative and postoperative management and long-term follow-up

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q21.3`	Tetralogy of Fallot	Common congenital lesion repaired in childhood that often leads to pulmonary regurgitation requiring later pulmonary valve replacement
`I35.0`	Nonrheumatic aortic (valve) stenosis	May be present as a concomitant valvular disease in adult congenital heart patients (listed for completeness)
`I37.9`	Pulmonary heart disease, unspecified	Reflects pulmonary valve pathology and right heart impact; used when more specific code not available
`I34.9`	Nonrheumatic mitral valve disorder, unspecified	Included when multivalvular disease is assessed or treated in the same patient
`I50.9`	Heart failure, unspecified	Documents symptomatic ventricular dysfunction secondary to chronic pulmonary regurgitation and right ventricular failure
`Q25.1`	Pulmonary valve atresia and stenosis	Direct congenital pulmonary valve abnormality that can lead to replacement in adulthood
`I42.8`	Other cardiomyopathies	Used when right ventricular hypertrophy and dysfunction progress to cardiomyopathic changes
`T82.2XXA`	Mechanical complication of other cardiac prosthetic devices, implants and grafts, initial encounter	Used for postoperative complications related to valve prostheses when applicable

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve	Performed when concomitant aortic valve disease is present; similar valve replacement technique and postoperative care
`33641`	Repair of congenital heart defect, intracardiac, with cardiopulmonary bypass; closure of ventricular septal defect	Performed in the same population of adult congenital patients; may be done previously or concurrently in complex repairs
`33426`	Replacement, pulmonary valve, with cardiopulmonary bypass; homograft or autograft	Alternative code used when a homograft/autograft is implanted rather than a standard prosthetic valve
`93458`	Right heart catheterization including pulmonary artery with hemodynamic monitoring	Commonly performed preoperatively or intraoperatively for hemodynamic assessment and decision-making
`99238`	Hospital discharge day management; 30 minutes or less	Used for billing the physician discharge encounter following postoperative stay
`33249`	Insertion of temporary transvenous pacing electrode with continuous monitoring	May be performed perioperatively for rhythm management when arrhythmia risk is high

CPT 33474: Pulmonary Valve Incision (Valvotomy) on Cardiopulmonary Bypass

CPT-33476-RIGHT-VENTRICULAR-RESECTION-INFUNDIBULAR-STENOSIS

CPT 33476: Right Ventricular Resection for Infundibular Stenosis

CPT-33477-PERCUTANEOUS-PULMONARY-VALVE-IMPLANTATION

CPT 33477: Percutaneous Pulmonary Valve Implantation

CPT-33478-VENTRICULAR-OUTFLOW-TRACT-ENLARGEMENT-WITH-GRAFT

CPT 33478: Ventricular Outflow Tract Enlargement with Graft

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier required / general clinical reporting	Not commonly appended; represents default reporting when no modifier applies
`11`	Primary procedure	Use when this pulmonary valve replacement is the primary reason for the encounter
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical expectations (document justification)
`23`	Unusual anesthesia	Use when general anesthesia is contraindicated and significantly different anesthesia techniques are used
`50`	Bilateral procedure	Not typically used for single-valve replacement; not applicable unless coding paired procedures
`51`	Multiple procedures	Use when additional distinct surgical procedures are performed in the same operative session
`52`	Reduced services	Use if the procedure is partially reduced or not completed as originally planned
`53`	Discontinued procedure	Use if the operation is started but aborted for patient safety reasons before completion
`62`	Two surgeons	Use when two surgeons work together as primary surgeons of record (co-surgeons) during the valve replacement
`63`	Procedure performed on infants younger than 4 kg	Generally not applicable to adult cases; applicable when patient meets weight criteria
`78`	Return to operating room for related procedure during postoperative period	Use when a related procedure is performed during the global period due to complications (e.g., hemorrhage)
`80`	Assistant surgeon	Use when an assistant surgeon provides surgical assistance during the valve replacement
`81`	Minimum assistant surgeon	Use when minimal assistance is provided (document level of assistance)
`AS`	Physician assistant, nurse practitioner, clinical nurse specialist services	Use when an advanced practice clinician performs or assists and services are billed per payer rules

Taxonomy Code	Specialty	Notes
207L00000X	Thoracic Surgery	Primary specialty for surgical pulmonary valve replacement
207P00000X	Cardiovascular Surgery	Common specialty for adult congenital and valve operations
2086S0122X	Cardiac Surgery	Focused cardiac surgical practice performing valve replacements
207RG0300X	Pediatric Cardiothoracic Surgery	In centers treating adult congenital heart disease, pediatric surgical expertise may be involved
208000000X	Cardiovascular Disease (Cardiology)	Cardiology provides preoperative and postoperative management and long-term follow-up

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q21.3`	Tetralogy of Fallot	Common congenital lesion repaired in childhood that often leads to pulmonary regurgitation requiring later pulmonary valve replacement
`I35.0`	Nonrheumatic aortic (valve) stenosis	May be present as a concomitant valvular disease in adult congenital heart patients (listed for completeness)
`I37.9`	Pulmonary heart disease, unspecified	Reflects pulmonary valve pathology and right heart impact; used when more specific code not available
`I34.9`	Nonrheumatic mitral valve disorder, unspecified	Included when multivalvular disease is assessed or treated in the same patient
`I50.9`	Heart failure, unspecified	Documents symptomatic ventricular dysfunction secondary to chronic pulmonary regurgitation and right ventricular failure
`Q25.1`	Pulmonary valve atresia and stenosis	Direct congenital pulmonary valve abnormality that can lead to replacement in adulthood
`I42.8`	Other cardiomyopathies	Used when right ventricular hypertrophy and dysfunction progress to cardiomyopathic changes
`T82.2XXA`	Mechanical complication of other cardiac prosthetic devices, implants and grafts, initial encounter	Used for postoperative complications related to valve prostheses when applicable

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve	Performed when concomitant aortic valve disease is present; similar valve replacement technique and postoperative care
`33641`	Repair of congenital heart defect, intracardiac, with cardiopulmonary bypass; closure of ventricular septal defect	Performed in the same population of adult congenital patients; may be done previously or concurrently in complex repairs
`33426`	Replacement, pulmonary valve, with cardiopulmonary bypass; homograft or autograft	Alternative code used when a homograft/autograft is implanted rather than a standard prosthetic valve
`93458`	Right heart catheterization including pulmonary artery with hemodynamic monitoring	Commonly performed preoperatively or intraoperatively for hemodynamic assessment and decision-making
`99238`	Hospital discharge day management; 30 minutes or less	Used for billing the physician discharge encounter following postoperative stay
`33249`	Insertion of temporary transvenous pacing electrode with continuous monitoring	May be performed perioperatively for rhythm management when arrhythmia risk is high

CPT 33474: Pulmonary Valve Incision (Valvotomy) on Cardiopulmonary Bypass

CPT-33476-RIGHT-VENTRICULAR-RESECTION-INFUNDIBULAR-STENOSIS

CPT 33476: Right Ventricular Resection for Infundibular Stenosis

CPT-33477-PERCUTANEOUS-PULMONARY-VALVE-IMPLANTATION

CPT 33477: Percutaneous Pulmonary Valve Implantation

CPT-33478-VENTRICULAR-OUTFLOW-TRACT-ENLARGEMENT-WITH-GRAFT

CPT 33478: Ventricular Outflow Tract Enlargement with Graft

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 33475: Pulmonary Valve Replacement

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Billing Code Overview

OpenPayer

CPT 33475: Pulmonary Valve Replacement

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References