CPT 33864 Aortic Root Replacement Reimbursement | OpenPayer

Summary & Overview

CPT 33864: Aortic Root and Proximal Ascending Aorta Replacement with Valved Graft

CPT code 33864 identifies an open cardiothoracic operation to repair a thoracic aortic aneurysm by replacing the aortic root and proximal ascending aorta with a tube graft that incorporates a prosthetic valve, with reimplantation of the coronary arteries and use of cardiopulmonary bypass. This is a high-complexity, resource-intensive procedure performed in inpatient surgical settings and is clinically significant for management of life-threatening aortic root pathology.

Key payers represented in the coverage discussion include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national-level overview of clinical context, typical sites of service, and common billing practices tied to this operative description. The publication also summarizes benchmarks and policy considerations relevant to high-acuity cardiothoracic procedures, highlights common modifiers used with this code, and outlines areas where coding and documentation influence claims processing. This content is intended to clarify the clinical scope of CPT code 33864, inform revenue cycle teams and clinical coders about the procedure’s billing context, and provide a concise reference for payers and healthcare administrators assessing coverage and payment for complex aortic root surgery.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33864CPTcardiothoracic surgeryaortic aneurysm repairvalved graftcardiopulmonary bypassinpatient surgery

Billing Code Overview

CPT code 33864 describes a surgical procedure to repair a thoracic aortic aneurysm by replacing the aortic root and proximal ascending aorta with a tube graft that contains a prosthetic valve and reimplanting the coronary arteries into the graft. The procedure includes initiation of cardiopulmonary bypass during the operation.

Service type: Complex open cardiac and aortic surgery involving valve-sparing/root replacement with prosthetic valved conduit and coronary reimplantation.
Typical site of service: Inpatient operating room with cardiothoracic surgery capabilities and cardiopulmonary bypass support.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a known ascending thoracic aortic aneurysm involving the aortic root and proximal ascending aorta presents with progressive aortic root dilation, severe aortic regurgitation, and symptoms of exertional dyspnea. Preoperative workup includes transthoracic and transesophageal echocardiography demonstrating a dilated aortic root with poor valve coaptation, CT angiography confirming aneurysmal dilation of the root and proximal ascending aorta, coronary angiography to define coronary ostia anatomy, and standard preoperative labs and cardiac risk assessment. The surgical team plans an open aortic root replacement with a composite valve-graft (Bentall-type) using a prosthetic valved conduit and reimplantation of the coronary ostia. General endotracheal anesthesia is induced in the operating room; median sternotomy provides chest access. The surgeon initiates cardiopulmonary bypass, excises the diseased aortic root and proximal ascending aorta, implants a tube graft containing a prosthetic valve, and reimplants the coronary arteries into the graft. Hemostasis is achieved, the patient is weaned from bypass, and he is transferred to the cardiac intensive care unit for postoperative monitoring and management of anticoagulation and hemodynamics. Typical site of service is an inpatient hospital operating room with subsequent postoperative care in an intensive care unit. Service type is an open cardiac surgical procedure (aortic root and ascending aorta replacement with prosthetic valved conduit) requiring cardiopulmonary bypass and cardiothoracic surgical specialty care.

Coding Specifications

Modifier	Description	When to Use
`62`

CPT 33859: Ascending Aortic Aneurysm Repair with Graft and Bypass

CPT-33863-AORTIC-ROOT-PROXIMAL-ASCENDING-AORTA-REPLACEMENT-VALVE-CONDUIT

CPT 33863: Aortic Root and Proximal Ascending Aorta Replacement with Valve Conduit

CPT-33866-AORTIC-ARCH-GRAFT-WITH-CIRCULATORY-ARREST

CPT 33866: Aortic Arch Graft Placement with Circulatory Arrest

CPT-33875-DESCENDING-THORACIC-AORTA-REPLACEMENT-GRAFT

CPT 33875: Descending Thoracic Aorta Replacement with Graft

CPT-33877-THORACOABDOMINAL-AORTIC-REPAIR-WITH-GRAFT

CPT 33877: Thoracoabdominal Aortic Repair with Graft

CPT-33871-AORTIC-ARCH-REPAIR-SYNTHETIC-GRAFT-CEREBRAL-ISOLATION

CPT 33871: Aortic Arch Repair with Synthetic Graft and Cerebral Isolation

CPT-33858-AORTIC-DISSECTION-REPAIR-WITH-GRAFT-AND-CARDIOPULMONARY-BYPASS

CPT 33858: Aortic Dissection Repair with Graft and Cardiopulmonary Bypass

Taxonomy Code	Specialty	Notes
207L00000X	Thoracic Surgery	Thoracic/cardiovascular surgeons commonly perform aortic root replacement procedures.
207P00000X	Cardiovascular Surgery	Cardiovascular surgeons with adult cardiac focus frequently perform this operation.
207KL0004X	Cardiac Surgery	Cardiac surgeons (congenital/adult) perform complex aortic root procedures.
207R00000X	General Surgery	General surgeons with cardiothoracic training may be involved in some centers (less common).
207T00000X	Vascular Surgery	Vascular surgeons may be involved when proximal ascending aortic pathology requires combined expertise.

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

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve	Performed if isolated aortic valve replacement is required or as component of valve procedures; conceptually related to implantation of prosthetic valve within a graft.
`33860`	Replacement, ascending aorta with graft, without cardiopulmonary bypass	Related for ascending aortic replacement procedures when bypass is not used; contrasts with `33864` which includes bypass and root replacement with valve conduit.
`33426`	Aortic valve repair; with cardiopulmonary bypass	Alternative when valve-sparing root repair is attempted instead of valve-containing graft; relevant to intraoperative decision-making.
`33999`	Unlisted procedure, cardiothoracic vascular system	Used for atypical or additional thoracic aortic procedures not described by existing codes; occasionally used for adjunctive procedures.
`00530`	Anesthesia for procedures on the heart and pericardial sac	Anesthesia service code typically billed by anesthesiology for open cardiac procedures including aortic root replacement.

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