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CPT 33496: Prosthetic Valve Repair on Cardiopulmonary Bypass

CPT code 33496 represents an open cardiac surgical procedure to repair a dysfunctional or leaking prosthetic heart valve while the patient is supported on cardiopulmonary bypass. This code captures complex intraoperative management of prosthetic valve dysfunction due to tissue overgrowth or exudative material impairing valve function. Nationally, accurate coding for these high-acuity cardiac surgeries affects case mix classification, hospital billing, and clinical quality measurement for valvular interventions.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage considerations, common modifiers, and the clinical context for using 33496 in surgical coding workflows.

Readers will learn the clinical intent of the code, typical site and service setting, and the administrative context for reporting this complex cardiac repair. The summary provides benchmarks and policy-relevant points where available, highlights common documentation elements tied to prosthetic valve repair on bypass, and notes when input data was not provided. Data not available in the input is indicated where applicable.

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Billing Code Overview

CPT code 33496 describes a surgical repair of a dysfunctional or leaking prosthetic heart valve performed while the patient is on cardiopulmonary bypass. The procedure addresses valve malfunction caused by overgrowth of vascular structures or exudate affecting the prosthetic valve.

Service Type: Cardiac surgical procedure — prosthetic valve repair on cardiopulmonary bypass

Typical Site of Service: Inpatient operating room or cardiac surgical suite (hospital-based)

Data not available in the input.

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CPT 33496: Prosthetic Valve Repair on Cardiopulmonary Bypass

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Get alerted when payer policies referencing 33496 are released or updated.

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Billing Code Overview

Service Type: Cardiac surgical procedure — prosthetic valve repair on cardiopulmonary bypass

Typical Site of Service: Inpatient operating room or cardiac surgical suite (hospital-based)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with a prior mechanical aortic valve prosthesis presents with progressive heart failure symptoms and new systolic murmurs. Transthoracic and transesophageal echocardiography demonstrate prosthetic valve dysfunction with obstructive pannus formation and vegetative exudate causing restricted leaflet motion and moderate-to-severe regurgitation. The cardiac surgery team schedules an open procedural intervention with the patient placed on cardiopulmonary bypass to perform debridement and repair of the dysfunctional prosthetic valve. Intraoperative transesophageal echocardiography is used for guidance, and the operative workflow includes median sternotomy, institution of cardiopulmonary bypass, excision of overgrown tissue and exudate from the prosthesis, assessment of valve function, and repair or partial reconstruction of the prosthetic apparatus. Postoperative care includes intensive monitoring in the cardiac surgical unit, anticoagulation management for mechanical prostheses, and follow-up echocardiography to confirm valve competence.

Coding Specifications

Modifier	Description	When to Use
`00`	Procedure furnished in whole or in part by the primary payer	Rare administrative use when primary payer performed part of service
`11`	Normal, routine service	When the procedure was routine without unusual circumstances
`22`	Increased procedural services	When work or time substantially exceeds typical for `33496`
`23`	Unusual anesthesia for patient condition	When neuraxial/other standard anesthesia is not appropriate due to patient risk
`26`	Professional component	When reporting only the surgeon’s professional component distinct from technical services
`50`	Bilateral procedure	If identical valve repair is performed on mirrored prostheses in a bilateral context (rare)
`62`	Two surgeons	When two surgeons perform distinct parts of the operative repair concurrently
`66`	Surgical team approach	When a surgical team of multiple surgeons provides the service due to complexity
`78`	Unplanned return to the operating room following the initial procedure	For a staged reoperation related to the original valve repair during the global period
`80`	Assistant surgeon	When a surgical assistant participates in the procedure and is reported separately
`81`	Minimum assistant surgeon	When a minimal assistant surgeon role meets payer criteria
`82`	Assistant surgeon (when qualified resident not available)	Use when no qualifying resident is available and an assistant is required
`52`	Reduced services	When the procedure is partially reduced or not completed as planned
`53`	Discontinued procedure	When the procedure is started but terminated due to patient-related or intraoperative issues

Taxonomy Code	Specialty	Notes
207RG0100X	Cardiothoracic Surgery	Primary specialty performing prosthetic valve repair on cardiopulmonary bypass
207RH0000X	Thoracic Surgery	Surgeons with thoracic focus who manage complex prosthetic valve pathology
2080P0006X	Cardiac Surgery	Cardiac surgeons specializing in valvular interventions and open-heart procedures
208000000X	General Surgery	In some centers, cardiothoracic-trained surgeons are cross-listed; general surgeons do not commonly perform this procedure
207L00000X	Vascular Surgery	May be involved when complex aortic root or annular reconstruction is required

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Replacement, aortic valve, with cardiopulmonary bypass	Alternative definitive treatment when valve repair is not feasible; may be performed if prosthetic repair fails
`33426`	Repair, mitral valve, with cardiopulmonary bypass; with prosthetic ring	Related mitral valve repair technique; similar operative setting and use of bypass when addressing prosthetic mitral pathology
`93503`	Reporting and interpretation of intraoperative transesophageal echocardiography (TEE) for structural heart disease	Intraoperative TEE is commonly performed before and after `33496` to assess prosthetic valve function and repair adequacy
`33430`	Replacement, mitral valve, with cardiopulmonary bypass	Converted procedure when mitral prosthetic repair is not possible and replacement is required
`99100`	Anesthesia for patient of extreme age, younger than 1 year and older than 70 (add-on)	Add-on anesthesia consideration for older patients undergoing complex cardiopulmonary bypass procedures

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`	Procedure furnished in whole or in part by the primary payer	Rare administrative use when primary payer performed part of service
`11`	Normal, routine service	When the procedure was routine without unusual circumstances
`22`	Increased procedural services	When work or time substantially exceeds typical for `33496`
`23`	Unusual anesthesia for patient condition	When neuraxial/other standard anesthesia is not appropriate due to patient risk
`26`	Professional component	When reporting only the surgeon’s professional component distinct from technical services
`50`	Bilateral procedure	If identical valve repair is performed on mirrored prostheses in a bilateral context (rare)
`62`	Two surgeons	When two surgeons perform distinct parts of the operative repair concurrently
`66`	Surgical team approach	When a surgical team of multiple surgeons provides the service due to complexity
`78`	Unplanned return to the operating room following the initial procedure	For a staged reoperation related to the original valve repair during the global period
`80`	Assistant surgeon	When a surgical assistant participates in the procedure and is reported separately
`81`	Minimum assistant surgeon	When a minimal assistant surgeon role meets payer criteria
`82`	Assistant surgeon (when qualified resident not available)	Use when no qualifying resident is available and an assistant is required
`52`	Reduced services	When the procedure is partially reduced or not completed as planned
`53`	Discontinued procedure	When the procedure is started but terminated due to patient-related or intraoperative issues

Taxonomy Code	Specialty	Notes
207RG0100X	Cardiothoracic Surgery	Primary specialty performing prosthetic valve repair on cardiopulmonary bypass
207RH0000X	Thoracic Surgery	Surgeons with thoracic focus who manage complex prosthetic valve pathology
2080P0006X	Cardiac Surgery	Cardiac surgeons specializing in valvular interventions and open-heart procedures
208000000X	General Surgery	In some centers, cardiothoracic-trained surgeons are cross-listed; general surgeons do not commonly perform this procedure
207L00000X	Vascular Surgery	May be involved when complex aortic root or annular reconstruction is required

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Replacement, aortic valve, with cardiopulmonary bypass	Alternative definitive treatment when valve repair is not feasible; may be performed if prosthetic repair fails
`33426`	Repair, mitral valve, with cardiopulmonary bypass; with prosthetic ring	Related mitral valve repair technique; similar operative setting and use of bypass when addressing prosthetic mitral pathology
`93503`	Reporting and interpretation of intraoperative transesophageal echocardiography (TEE) for structural heart disease	Intraoperative TEE is commonly performed before and after `33496` to assess prosthetic valve function and repair adequacy
`33430`	Replacement, mitral valve, with cardiopulmonary bypass	Converted procedure when mitral prosthetic repair is not possible and replacement is required
`99100`	Anesthesia for patient of extreme age, younger than 1 year and older than 70 (add-on)	Add-on anesthesia consideration for older patients undergoing complex cardiopulmonary bypass procedures

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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.