Summary & Overview
CPT 33987: Arterial Graft Creation for ECMO/ECLS
CPT code 33987 is an add-on surgical code for creation of an arterial graft channel to achieve arterial perfusion for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). As an adjunct procedure during initiation of ECMO/ECLS, this service supports circulation and oxygenation when native arterial access is inadequate or when a graft is preferred for cannulation. Nationally, the code matters because ECMO/ECLS utilization has expanded in tertiary and quaternary acute care centers, and clear coding for vascular access procedures affects clinical documentation, hospital billing, and resource planning.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The review addresses how CPT code 33987 is described and categorized and provides context for clinical use during ECMO/ECLS initiation.
Readers will learn the clinical context for the code, the typical site of service and service type, and what is and is not available in the input data for associated coding elements. The publication summarizes benchmarks and policy-relevant considerations where available and flags items noted as "Data not available in the input" when certain payer-specific or coding-detail fields were not provided.
Billing Code Overview
CPT code 33987 is an add-on vascular graft creation procedure performed to establish arterial perfusion specifically for extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). The service involves creation of a graft channel to facilitate arterial access and perfusion when ECMO/ECLS support is required.
Service type: Surgical vascular access procedure to establish arterial perfusion for ECMO/ECLS
Typical site of service: Operating room or hybrid/endovascular suite in an acute care hospital setting (intensive care unit environment for initiation of ECMO/ECLS)
Clinical & Coding Specifications
Clinical Context
A critically ill adult with severe cardiopulmonary failure is placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock after an acute myocardial infarction. Surgical vascular access via creation of a graft channel is required to establish arterial perfusion for the ECMO circuit because percutaneous cannulation is not feasible due to small or diseased vessels. The patient is taken to the operating room under general anesthesia. The cardiovascular surgeon exposes the femoral or axillary artery, creates an arteriotomy, and sews a synthetic or autologous graft conduit to the artery to allow secure arterial inflow for ECMO cannulation. Intraoperative steps include hemostasis, tunneling of the graft as needed, securing the graft to minimize kinking, and confirming adequate arterial flow into the ECMO circuit. Postoperative workflow includes ICU transfer, monitoring of limb perfusion, anticoagulation management, and documentation of the vascular graft creation and ECMO initiation. Billing uses the add-on code 33987 in conjunction with primary ECMO cannulation and circuit management codes when a graft channel is created specifically to achieve arterial perfusion for ECMO/ECLS.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | When two surgeons of different specialties work together as primary surgeons during the procedure |