CPT 33871 Aortic Arch Repair Reimbursement | OpenPayer

Summary & Overview

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

CPT code 33871 denotes complex open surgical repair of the aortic arch with placement of a synthetic graft while isolating cerebral circulation via intermittent cardiopulmonary bypass or deep hypothermic circulatory arrest. This high‑acuity procedure is performed to treat defects such as aneurysms of the aortic arch and carries significant perioperative risk and resource use, making accurate coding essential for clinical reporting, quality measurement, and payer adjudication. Nationally, the code is relevant to tertiary cardiovascular centers and affects payer coverage decisions, bundled payment considerations, and registry reporting.

This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical procedure and typical setting, a summary of common modifiers observed in billing practice, and context for how the code is used in surgical and hospital service lines. The publication also outlines expected documentation elements, typical sites of service, and where to find related coding guidance. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33871CPTaortic-arch-repaircardiothoracic-surgerydeep-hypothermic-circulatory-arrestcardiopulmonary-bypassinpatient-surgeryvascular-surgery

Billing Code Overview

CPT code 33871 describes surgical repair of a defect in the aortic arch using a synthetic graft while the patient is supported with intermittent cardiopulmonary bypass or deep hypothermic circulatory arrest. The procedure isolates cerebral circulation from systemic circulation and involves reimplantation of the arch vessels either individually or as a two‑ or three‑vessel Carrel patch graft.

Service type: Major open cardiothoracic aortic surgery involving circulatory arrest or cardiopulmonary bypass.
Typical site of service: Inpatient operating room, typically within a tertiary care or specialized cardiovascular surgical center.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male presents with a symptomatic thoracic aortic arch aneurysm identified on CT angiography after episodes of chest pain and hoarseness. Imaging demonstrates a fusiform aneurysmal dilation involving the aortic arch with involvement of the origins of the innominate and left common carotid arteries. The cardiovascular surgery team schedules an open aortic arch repair under intermittent cardiopulmonary bypass with periods of deep hypothermic circulatory arrest to permit safe isolation of cerebral circulation. The procedure includes excision of the diseased arch segment and placement of a synthetic Dacron arch graft with individual reimplantation of the arch vessels using a three-vessel Carrel patch technique.

Preoperative workflow includes multidisciplinary evaluation (cardiac anesthesia, perfusion, neuromonitoring), informed consent, CT angiography and cerebral perfusion planning, laboratory optimization, and cardiopulmonary bypass and hypothermia planning. Intraoperative workflow includes median sternotomy (± extension to neck or left thoracotomy if needed), systemic heparinization, initiation of cardiopulmonary bypass, cooling to target temperature, periods of deep hypothermic circulatory arrest with cerebral protection (antegrade or retrograde cerebral perfusion as indicated), excision of the arch aneurysm, placement of a synthetic graft, individual reimplantation of arch vessels or Carrel patch, rewarming on bypass, hemostasis, and transfer to CVICU for postoperative monitoring of neurologic and end-organ function.

Typical site of service is an inpatient tertiary hospital operating room with cardiothoracic surgical services and cardiopulmonary bypass capability. The service type is major cardiovascular surgery requiring cardiopulmonary bypass and specialized perfusion and anesthesia teams.

Coding Specifications

Modifier	Description	When to Use

CPT 33877: Thoracoabdominal Aortic Repair with Graft

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

CPT 33875: Descending Thoracic Aorta Replacement with Graft

CPT-33864-AORTIC-ROOT-AND-ASCENDING-AORTA-REPLACEMENT-WITH-VALVED-GRAFT

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

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

CPT 33866: Aortic Arch Graft Placement with Circulatory Arrest

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

CPT 33858: Aortic Dissection Repair with Graft and Cardiopulmonary Bypass

CPT-33859-ASCENDING-AORTIC-ANEURYSM-REPAIR-WITH-GRAFT-BYPASS

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

Taxonomy Code	Specialty	Notes
`334E00000X`	Cardiothoracic Surgery	Primary specialty performing open aortic arch repair
`207L00000X`	Vascular Surgery	May perform complex aortic arch repairs in some centers
`207K00000X`	Cardiac Surgery	Overlaps with cardiothoracic specialists performing major aortic procedures
`208100000X`	Anesthesiology	Cardiac anesthesiologists manage bypass and hypothermia and intraoperative hemodynamics
`3336S0105X`	Perfusionist	Clinical perfusionists operate cardiopulmonary bypass and circulatory support

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I71.2`	Thoracic aortic aneurysm, ruptured	Emergent indication for arch repair when rupture involves the arch
`I71.1`	Thoracic aortic aneurysm, dissection	Aortic dissection involving the arch often necessitates open arch replacement
`I71.3`	Thoracic aortic aneurysm, without rupture	Elective indication for repair when size or symptoms meet criteria
`I71.8`	Thoracic aortic aneurysm, other	Non-specified thoracic aortic aneurysm involving arch anatomy
`I71.9`	Aortic aneurysm, unspecified	Used when specific location coding is unclear but arch pathology present

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33701`	Resection of thoracic aorta, proximal (ascending) and repair with graft, with or without cardioplegia; for acute dissection or aneurysm	May be performed when ascending aorta is involved in addition to arch; often coded when repair extends into the ascending aorta
`33860`	Replacement, with prosthesis, of the aortic root and ascending aorta	Performed when root and ascending aorta require replacement in conjunction with arch repair; may precede or be combined with `33871`
`33945`	Valve procedures (replacement) — examples for reference	Valve replacement may be performed concurrently if the aortic valve is diseased; coded separately when performed during the same operative session
`92973`	Percutaneous transcatheter procedures (example placeholder)	Data not available in the input
`00530`	Anesthesia for procedures on upper abdomen; complex cardiac anesthesia codes exist separately	Anesthesia coding for cardiopulmonary bypass and deep hypothermic circulatory arrest is reported using appropriate cardiac anesthesia codes concurrent with `33871`

`00`	Default/No specific modifier	Standard reporting when no additional modifier applies
`11`	Office or other outpatient service, new or established	Rarely used for this inpatient operative procedure; not typical for `33871`
`22`	Increased procedural services	Use when operative complexity or time substantially exceeds usual for `33871` and documentation supports increased work
`23`	Unusual anesthesia — medically necessary	Use when general anesthesia is not performed due to unusual circumstances; rarely applicable to open arch repair
`50`	Bilateral procedure	Not typically applicable to `33871` but listed when procedures are bilateral (usually not used)
`62`	Two surgeons	Use when two surgeons work together as primary surgeons, both substantially performing portions of the procedure
`78`	Unplanned return to the operating room following the initial procedure for a related procedure during the postoperative period	Use if the patient has an unplanned reoperation related to the initial arch repair during the global period
`79`	Data not provided in input	Data not available in the input
`80`	Assistant surgeon	Use when an assistant surgeon provides significant assistance; documentation required
`81`	Minimum assistant surgeon	Use when a surgical assistant provides only minimal assistance
`82`	Assistant surgeon (when qualified resident not available)	Use when no qualified resident is available and an assistant is required
`63`	Procedure performed on infants less than 4 kg	Rarely relevant for adult aortic arch repair; include only if applicable
`66`	Surgical team approach	Use when multiple surgeons from different specialties perform a complex procedure as a team
`62`	Two surgeons (duplicate entry removed)	Data not available in the input

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