CPT 33974 Intra‑Aortic Balloon Removal Reimbursement | OpenPayer

Summary & Overview

CPT 33974: Removal of Intra–Aortic Balloon with Ascending Aortic Repair

CPT code 33974 denotes surgical removal of a previously placed intra–aortic balloon from the ascending aorta with concurrent repair of the ascending aorta, which may involve graft use. This procedure is generally performed after patient stabilization following initial hemodynamic support and is distinct from the balloon placement procedure. Nationally, this code is relevant for acute cardiovascular surgical care, perioperative resource planning, and coding clarity for hospitals and cardiac surgery programs.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of the code, typical sites of service, and payer coverage considerations. The publication outlines where this service fits into surgical workflows, coding boundaries (placement versus removal/repair), and common clinical scenarios that prompt use of the code.

The report summarizes benchmarking and reimbursement context where available, highlights policy or coverage considerations affecting hospitals and surgical teams, and clarifies reporting practices tied to intra–aortic balloon management. Data not available in the input is noted as such where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 33974intra-aortic balloonaortic repaircardiovascular surgeryinpatient surgeryoperative codingsurgical removalvascular graft

Billing Code Overview

CPT code 33974 describes the removal of a previously inserted intra–aortic balloon from the ascending aorta with repair of the ascending aorta, which may include use of a graft. The procedure is performed once the patient stabilizes after initial intervention. Placement of the intra–aortic balloon catheter is a separately reportable procedure.

Service type: Surgical removal of intra–aortic balloon with ascending aortic repair
Typical site of service: Hospital inpatient or operating room during cardiovascular surgery or postoperative reintervention

Clinical & Coding Specifications

Clinical Context

A typical patient is a hemodynamically unstable adult admitted to the cardiothoracic surgery service after acute myocardial infarction complicated by cardiogenic shock or severe left ventricular dysfunction. An intra-aortic balloon pump (IABP) was previously inserted percutaneously or via surgical cutdown into the ascending aorta to provide temporary mechanical circulatory support. Once the patient stabilizes hemodynamically, the cardiothoracic surgeon returns to the operating room or performs the removal at the bedside in a procedure area to explant the IABP, inspect and repair the ascending aorta at the insertion site, and, if required, perform patch repair or interposition grafting to restore vascular integrity. The workflow includes pre-procedure hemodynamic assessment, sedation or general anesthesia as indicated, sterile exposure of the aortic entry site, removal of the catheter, direct visualization of the aortic wall, repair or graft placement, hemostasis verification, and postoperative monitoring in the intensive care unit.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no specific modifier applies and standard services are reported.
`11`	Professional component

CPT 33993: Percutaneous Ventricular Assist Device Repositioning

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

CPT 33995: Percutaneous Right Heart Ventricular Assist Device Insertion

CPT-33976-VENTRICULAR-ASSIST-DEVICE-IMPLANTATION

CPT 33976: Ventricular Assist Device (VAD) Implantation

CPT-33979-IMPLANTABLE-VENTRICULAR-ASSIST-DEVICE-SINGLE-VENTRICLE

CPT 33979: Implantable Ventricular Assist Device Insertion, Single Ventricle

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

CPT 33970: Intra–Aortic Balloon Insertion via Femoral Artery

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

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

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

CPT 33969: Open Removal of Peripheral Extracorporeal Cannula, Pediatric

CPT-33973-ASCENDING-AORTIC-INTRA-AORTIC-BALLOON-INSERTION

CPT 33973: Ascending Aortic Insertion of Intra–Aortic Balloon

CPT-33978-VENTRICULAR-ASSIST-DEVICE-EXPLANTATION

CPT 33978: Ventricular Assist Device Explantation

CPT-33964-PEDIATRIC-CENTRAL-CANNULA-REPOSITIONING-OPEN-APPROACH

CPT 33964: Reposition Central Cannula for Extracorporeal Circulation, Pediatric

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Taxonomy Code	Specialty	Notes
208000000X	Thoracic Surgery	Primary specialty performing ascending aortic repairs and IABP management.
208100000X	Cardiac Surgery	Common specialty performing removal and aortic repair after cardiac procedures.
207K00000X	Cardiovascular Surgery	Surgeons specializing in vascular aspects of aortic repair and grafting.
207PR0000X	Interventional Cardiology	May be involved in initial IABP placement and coordination; less commonly performs the removal/repair.
363L00000X	Critical Care Medicine	Intensivists manage pre- and post-procedure hemodynamic stabilization and monitoring.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I21.3`	ST elevation (STEMI) myocardial infarction of other anterior wall	Acute MI leading to cardiogenic shock and need for temporary mechanical support such as IABP.
`I50.21`	Acute systolic (congestive) heart failure	Severe ventricular dysfunction prompting IABP insertion for hemodynamic support and later removal when stable.
`R57.0`	Cardiogenic shock	Direct indication for mechanical circulatory support including IABP; removal occurs after stabilization.
`I97.1`	Other postprocedural complications and disorders of circulatory system	Possible complications at the aortic entry site requiring repair during removal.
`T82.89XA`	Other complications of cardiac and vascular prosthetic devices, implants and grafts, initial encounter	Used when device-related complications necessitate explantation and aortic repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Repair of ascending aorta, with cardiopulmonary bypass, with graft	Major aortic repair that may be performed when definitive surgical reconstruction is required after IABP removal.
`33975`	Insertion of intra-aortic balloon catheter, percutaneous	The placement of the IABP is a separately reportable procedure that precedes the removal described by `33974`.
`99152`	Moderate sedation services provided by the same physician performing a procedure (initial 15 minutes)	May be reported when moderate sedation is provided during bedside removal if payer guidance allows.
`99291`	Critical care, evaluation and management of the critically ill patient; first 30-74 minutes	Critical care time associated with hemodynamic stabilization before or after removal of the IABP.
`35860`	Repair of vascular entry site (e.g., arterial)	Related vascular repair techniques applied to the aortic or arterial insertion site during explantation.

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