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    v1.0.30
    OpenPayerBilling CodesCardiac Assist ProceduresCPT cpt-33991-percutaneous-left-ventricular-assist-device-transseptal-insertion
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    CPT 33991: Percutaneous Left Ventricular Assist Device, Transseptal

    Medicare pays $416 on average nationally for this procedure.

    CPT code 33991 describes percutaneous insertion of a ventricular assist device (VAD) into the left heart using both venous and arterial access with a transseptal puncture under radiological guidance; service type: percutaneous transseptal VAD placement; typical site of service: cardiac catheterization laboratory or interventional radiology suite (inpatient or outpatient procedural setting).

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with refractory cardiogenic shock and severely reduced left ventricular ejection fraction is admitted to the cardiac intensive care unit. After multidisciplinary evaluation, the interventional cardiology and cardiothoracic surgery teams determine that urgent mechanical circulatory support is indicated. The provider performs a percutaneous ventricular assist device (VAD) insertion into the left heart under fluoroscopic and echocardiographic guidance. Vascular access is established via a femoral vein and femoral artery; a transseptal puncture is performed to traverse the interatrial septum and position the device in the left ventricle. Procedural steps include vascular access and hemostasis, transseptal needle puncture with intracardiac or transesophageal echocardiographic confirmation, device advancement and positioning under radiologic guidance, hemodynamic assessment, and post-placement monitoring in an intensive care setting. Typical pre-procedure documentation includes indications (e.g., cardiogenic shock), informed consent, imaging and lab results, anticoagulation plan, and device type. Post-procedure documentation includes device settings, hemodynamic parameters, complications (vascular injury, tamponade, stroke), and plan for device management or escalation to durable support or transplantation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    93458Catheter placement in coronary or pulmonary artery with hemodynamic measurements and imagingMay be performed before or during VAD insertion to assess hemodynamics and guide device selection
    93503Insertion of temporary transvenous pacing electrode, with or without removalMay be used in patients requiring temporary pacing support during or after VAD placement
    33361Transcatheter insertion of ventricular assist device, percutaneous, for right or left heart support (alternative codes for device types)Related percutaneous mechanical circulatory support codes used for coding cross-reference and device-specific reporting
    33405Repair of cardiac septal defect with device (transcatheter) — illustrative of transseptal access complexityProcedures involving transseptal puncture share technique elements; listed for procedural relationship and potential combined interventions
    92973Insertion and placement of intracardiac electrophysiology catheter for mapping or ablationMay be performed in hybrid procedures where electrophysiology and mechanical support coincide

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    2086S0122X
    207L00000X
    364S00000X
    174400000X
    224ZF0002X
    363L00000X
    364SX0204X

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

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

    CPT 33964: Reposition Central Cannula for Extracorporeal Circulation, Child 6+

    CPT-33965-PEDIATRIC-EXTRACORPOREAL-CANNULA-REMOVAL

    CPT 33965: Removal of Peripheral Cannula for Extracorporeal Circulation, Age 0–5

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

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

    CPT-33967-PERCUTANEOUS-INTRA-AORTIC-BALLOON-CATHETER-INSERTION

    CPT 33967: Percutaneous Intra‑Aortic Balloon Catheter Insertion

    CPT-33968-INTRA-AORTIC-BALLOON-REMOVAL-PERCUTANEOUS

    CPT 33968: Removal of Percutaneous Intra-Aortic Balloon

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

    CPT 33969: Removal of Peripheral Cannula for Extracorporeal Circulation, Child

    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: Removal of Intra‑Aortic Balloon and Femoral Artery Repair

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

    CPT 33973: Ascending Aorta Insertion of Intra–Aortic Balloon

    CPT-33974-INTRA-AORTIC-BALLOON-REMOVAL-ASCENDING-AORTIC-REPAIR

    CPT 33974: Removal of Intra–Aortic Balloon and Ascending Aorta Repair

    Showing 1–10 of 28

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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