CPT 33875 Descending Thoracic Aorta Replacement Reimbursement | OpenPayer

Summary & Overview

CPT 33875: Descending Thoracic Aorta Replacement with Graft

CPT code 33875 denotes replacement of the descending thoracic aorta with a graft, a high-acuity open thoracic aortic surgery that may be performed with cardiopulmonary bypass. This procedure is nationally significant because it addresses life-threatening aortic disease — including aneurysm and dissection — and involves substantial resource use, operative risk, and post-operative critical care.

Key payers evaluated include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and the typical hospital setting for this operation, plus the benchmarks and payment considerations commonly associated with major thoracic aortic procedures. The publication highlights expected utilization patterns, common billing and coding contexts, and areas where policy updates or payer-specific coverage rules often influence authorization and reimbursement workflows.

This summary equips hospital administrators, coding professionals, and clinical leaders with the context needed to align clinical documentation and billing for complex aortic surgery, understand payer engagement priorities, and monitor policy or guideline changes that affect access and payment for high-cost surgical interventions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33875CPTthoracic aorta replacementvascular surgerycardiothoracic surgeryinpatient surgerygraft replacementaortic aneurysmaortic dissection

Billing Code Overview

CPT code 33875 describes a surgical procedure in which the provider replaces the descending thoracic aorta with a graft. The description notes that the provider may perform this procedure with bypass.

Service type: Open thoracic aortic replacement — a major vascular surgery involving excision of the diseased segment of the descending thoracic aorta and insertion of a prosthetic graft.

Typical site of service: Inpatient hospital operating room, often performed by cardiothoracic or vascular surgeons and requiring perioperative intensive care given the complexity of the operation and potential need for cardiopulmonary bypass.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with progressive thoracic aortic aneurysm involving the descending thoracic aorta is scheduled for open surgical replacement of the descending thoracic aorta with a prosthetic graft (CPT 33875). The patient has hypertension, chronic obstructive pulmonary disease, and peripheral arterial disease. Preoperative workup includes CT angiography of the chest to define aneurysm extent, cardiopulmonary evaluation, and cerebral and spinal cord protection planning. In the operating room, a thoracotomy is performed; the diseased segment of the descending thoracic aorta is resected and replaced with a synthetic graft. Adjunctive measures may include partial cardiopulmonary bypass or left heart bypass for distal perfusion and spinal cord protection with cerebrospinal fluid drainage and distal aortic perfusion monitoring. Postoperative management includes intensive care unit monitoring, blood pressure control, neurologic checks for spinal cord ischemia, wound care, and planned imaging follow-up.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds usual for `CPT 33875` (document justification).

CPT 33866: Aortic Arch Graft Placement with Circulatory Arrest

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

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

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

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

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

CPT 33859: Ascending Aortic Aneurysm Repair with Graft and Bypass

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

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

CPT 33877: Thoracoabdominal Aortic Repair with Graft

Taxonomy Code	Specialty	Notes
207L00000X	Cardiothoracic Surgery	Primary specialty performing open descending thoracic aortic replacement.
2080P0003X	Vascular Surgery	Often involved for complex aortic pathology and hybrid approaches.
207RP1001X	Thoracic Surgery	Surgeons with thoracic focus who perform open thoracic aortic procedures.
208000000X	General Surgery	May assist in hybrid or complex cases, less commonly primary for thoracic aorta.
208100000X	Cardiac Surgery	Cardiac surgeons with experience in aortic surgery and bypass management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I71.2`	Thoracic aortic aneurysm, ruptured	Indicates emergent replacement of the descending thoracic aorta for rupture.
`I71.3`	Thoracic aortic aneurysm, without rupture	Common indication for elective `CPT 33875` when aneurysm meets size or growth criteria.
`I71.4`	Abdominal aortic aneurysm, ruptured	Less directly related; included for completeness when aneurysm extends across thoracoabdominal segments.
`I71.1`	Thoracoabdominal aortic aneurysm, ruptured	Relevant when disease spans thoracic and abdominal segments requiring complex repair.
`I71.9`	Aortic aneurysm, unspecified	Used when documentation does not specify location; limited specificity for surgical planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33210`	Insertion of temporary transvenous pacemaker, with or without removal	Used intraoperatively or postoperatively if temporary pacing is required for conduction disturbances.
`36415`	Collection of venous blood by venipuncture	Routine perioperative labs including blood typing and crossmatch prior to `CPT 33875`.
`34701`	Bypass graft, with prosthesis; thoracic aorta	Alternative or adjunct grafting codes relevant to thoracic aortic reconstruction (select when specific approach aligns).
`77012`	CT guidance for needle placement (diagnostic)	Preoperative CT angiography planning and intraoperative image guidance may be billed separately when applicable.
`99100`	Anesthesia for patient of extreme age, under 1 year and over 70 years of age	Consideration for anesthesia reporting when applicable to this older patient population (use per payer rules).

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