CPT 33973 Ascending Aortic IABP Reimbursement | OpenPayer

Summary & Overview

CPT 33973: Ascending Aortic Insertion of Intra–Aortic Balloon

CPT code 33973 identifies surgical insertion of an intra–aortic balloon via the ascending aorta for patients who cannot receive device placement through the femoral route. This code captures a specialized approach to mechanical circulatory support used in cardiac surgery and critical care when peripheral vascular access is compromised. Nationally, use of this code reflects cases requiring open or direct aortic access and is relevant to hospital procedural registries, surgical billing, and payer coverage determinations. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when ascending aortic intra–aortic balloon placement is used, the typical site of service, and the procedural focus of the code. The publication also summarizes common billing modifiers for related services and highlights benchmarking and policy considerations where available. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and payer-specific reimbursement rates are noted as such elsewhere. This resource is intended to clarify the clinical and billing identity of CPT code 33973 and to support coding accuracy and administrative workflows at a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33973CPTintra-aortic ballooncardiac surgerymechanical circulatory supportascending aortaoperating room procedures

Billing Code Overview

CPT code 33973 describes insertion of an intra–aortic balloon via the ascending aorta for patients whose blood flow is compromised and for whom a femoral approach is not feasible. The procedure involves direct placement of an intra–aortic balloon catheter through the ascending aorta to provide mechanical circulatory support in situations where peripheral vascular access is unavailable or contraindicated.

Service type: Surgical insertion of intra–aortic balloon via ascending aorta
Typical site of service: Intraoperative setting in an operating room or hybrid cardiac surgical suite where open or direct aortic access is performed

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of severe peripheral arterial disease and cardiogenic shock after an extensive anterior ST-elevation myocardial infarction is brought to the hybrid operating room. The patient requires mechanical circulatory support with an intra-aortic balloon pump (IABP), but prior femoral access attempts are unsuccessful due to bilateral iliofemoral occlusive disease and prior vascular surgery. The cardiovascular surgeon elects to place an IABP via direct ascending aortic insertion through a limited upper midline or right anterior thoracotomy approach under general anesthesia. The workflow includes preoperative review of imaging and coagulation status, coordination with perfusion and anesthesia teams, sternotomy or limited thoracotomy exposure of the ascending aorta, insertion and securement of the balloon catheter with fluoroscopic and transesophageal echocardiographic confirmation of placement, hemodynamic optimization, and postoperative monitoring in the cardiac intensive care unit. Documentation includes indication (e.g., cardiogenic shock or refractory myocardial ischemia), description of the alternate ascending aortic approach, anesthesia and monitoring details, device type and size, confirmation of position, estimated blood loss, and any intraoperative complications or conversions.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the procedure concurrently or sequentially.

CPT 33991: Percutaneous Left Ventricular Assist Device Insertion

CPT-33969-PEDIATRIC-OPEN-PERIPHERAL-CANNULA-REMOVAL-EXTRACORPOREAL

CPT 33969: Open Removal of Peripheral Extracorporeal Cannula, Pediatric

CPT-33970-INTRA-AORTIC-BALLOON-INSERTION-FEMORAL-ARTERY

CPT 33970: Intra–Aortic Balloon Insertion via Femoral Artery

CPT-33971-INTRA-AORTIC-BALLOON-REMOVAL-FEMORAL-ARTERY-REPAIR

CPT 33971: Intra–Aortic Balloon Removal with Femoral Artery Repair

CPT-33965-PEDIATRIC-EXTRACORPOREAL-CANNULA-REMOVAL

CPT 33965: Peripheral Cannula Removal for Extracorporeal Circulation, Pediatric

CPT-33989-LEFT-HEART-VENT-CATHETER-REMOVAL-ECMO-ECLS

CPT 33989: Removal of Left Heart Vent Catheter During ECMO/ECLS

CPT-33985-PEDIATRIC-CENTRAL-CANNULA-REMOVAL-OPEN-STERNOTOMY-THORACOTOMY

CPT 33985: Pediatric Central Cannula Removal via Open Sternotomy/Thoracotomy

CPT-33982-VAD-PUMP-REPLACEMENT-SINGLE-VENTRICLE-NO-BYPASS

CPT 33982: VAD Pump Replacement, Single Ventricle, No Bypass

CPT-33995-PERCUTANEOUS-RIGHT-HEART-VENTRICULAR-ASSIST-DEVICE-INSERTION

CPT 33995: Percutaneous Right Heart Ventricular Assist Device Insertion

CPT-33966-PERIPHERAL-CANNULA-REMOVAL-EXTRACORPOREAL-CIRCULATION-CHILD

CPT 33966: Peripheral Cannula Removal for Extracorporeal Circulation, Child ≥6 Years

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Taxonomy Code	Specialty	Notes
2080S0102X	Cardiothoracic Surgery	Surgeons who perform ascending aortic access and open cardiac surgical procedures.
207RC0000X	Interventional Cardiology	Interventional cardiologists who may be involved in device placement and hemodynamic management.
208100000X	Vascular Surgery	Vascular surgeons who manage complex access limitations and alternative aortic access.
1744S0201X	Critical Care Medicine	Intensivists who manage postoperative mechanical circulatory support in the ICU.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I21.3`	ST elevation (STEMI) myocardial infarction of unspecified site	STEMI with hemodynamic compromise may require IABP support when femoral access is not feasible.
`R57.0`	Cardiogenic shock	Primary indication for mechanical circulatory support via IABP insertion.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Severe peripheral arterial occlusive disease may preclude femoral access, prompting ascending aortic approach.
`I70.2`	Atherosclerosis of native arteries of the extremities	Advanced peripheral vascular disease impacting femoral access selection.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Underlying coronary disease often present in patients requiring temporary mechanical support.
`T82.898A`	Other mechanical complication of other cardiac device, initial encounter	Relevant when prior device complications influence access choice or require alternative insertion sites.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33970`	Insertion of intra-aortic balloon catheter, percutaneous, with imaging guidance	Often performed when femoral percutaneous access is possible; alternative to ascending aortic approach.
`33974`	Removal of intra-aortic balloon catheter, percutaneous or via open approach	Performed when device is weaned and no longer required; may follow `33973` for removal via chest approach.
`00540`	Anesthesia for procedures on heart and pericardial sac	Anesthesia codes (example category) apply for general anesthesia during open ascending aortic IABP insertion.
`00530`	Anesthesia for thoracic procedures	Used when thoracotomy approach is used for ascending aortic access; documents anesthesia component associated with the operative service.
`93503`	Right heart catheterization including hemodynamic measurements	May be performed pre- or intra-procedurally to assess cardiac output and guide need for IABP support.

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