CPT 92986 Balloon Aortic Valvuloplasty Reimbursement | OpenPayer

Summary & Overview

CPT 92986: Balloon Aortic Valvuloplasty, Percutaneous

CPT code 92986 represents percutaneous balloon aortic valvuloplasty, a minimally invasive procedure to dilate a stenotic aortic valve and improve blood flow. The code captures a therapeutic catheter-based intervention used in acute and palliative settings, and it remains relevant nationally for hospitals and interventional cardiology programs managing symptomatic aortic stenosis or as a bridge to definitive therapy.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find clinical context for the procedure, typical sites of service, and the operational implications for hospital and outpatient interventional suites. The publication outlines common modifiers and coding considerations, payer coverage patterns, and how CPT code 92986 fits within broader valvular intervention billing strategies.

This summary provides benchmarks for utilization and reimbursement patterns, highlights policy updates affecting coverage and prior authorization for transcatheter valve procedures, and explains how documentation and coding map to clinical workflows. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 92986balloon aortic valvuloplastyinterventional cardiologycardiac catheterizationvalvular heart diseasepercutaneous valve interventionprocedure codinghospital outpatient

Billing Code Overview

CPT code 92986 describes a balloon aortic valvuloplasty, a catheter-based procedure in which a provider opens a stenotic aortic valve using a balloon catheter to improve blood flow through the valve. The procedure involves advancing a catheter with an inflatable balloon across the narrowed aortic valve and inflating the balloon to dilate the valve orifice.

Service Type: Percutaneous transcatheter valvular intervention

Typical Site of Service: Cardiac catheterization laboratory or interventional cardiology suite, often performed in an inpatient or outpatient hospital setting depending on clinical status and facility resources.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with symptomatic aortic stenosis presenting with exertional dyspnea, angina, syncope, or heart failure symptoms. The patient undergoes pre-procedure evaluation including transthoracic and/or transesophageal echocardiography demonstrating a calcified, stenotic aortic valve with elevated transvalvular gradients and aortic valve area consistent with severe or critical stenosis. Cardiology performs diagnostic coronary angiography to assess coronary anatomy when indicated. Balloon aortic valvuloplasty (92986) is scheduled in the cardiac catheterization laboratory under conscious sedation or general anesthesia when the clinical goal is transient hemodynamic improvement, bridge to definitive therapy (surgical aortic valve replacement or transcatheter aortic valve replacement), palliation in high-risk patients, or stabilization in cardiogenic shock.

Typical clinical workflow:

Pre-procedure: informed consent, review of echocardiography and angiography, anticoagulation and antiplatelet management, baseline labs.
Procedure: arterial access (commonly femoral), placement of a balloon aortic valvuloplasty catheter across the aortic valve under fluoroscopic and hemodynamic guidance, sequential balloon inflation(s) with hemodynamic assessment, and post-dilation monitoring. Temporary pacing may be used.
Post-procedure: vascular access closure, monitoring for complications (valve regurgitation, vascular injury, stroke), repeat echocardiography or hemodynamics to document gradient reduction, and disposition planning (same-day observation, short inpatient stay, or transfer for definitive valve therapy).

Typical site of service: hospital-based cardiac catheterization laboratory, cardiac catheterization suite, or hybrid operating room. Typical service type: interventional cardiology procedure.

Coding Specifications

CPT 92998: Pulmonary Artery Balloon Angioplasty, Additional Vessel

CPT-92997-PULMONARY-ARTERY-BALLOON-ANGIOPLASTY-SINGLE-VESSEL

CPT 92997: Pulmonary Artery Balloon Angioplasty, Single Vessel

CPT-92990-PULMONARY-VALVE-BALLOON-VALVULOPLASTY

CPT 92990: Pulmonary Valve Balloon Valvuloplasty

CPT-92978-INTRAVASCULAR-IMAGING-INTERPRETATION-CORONARY-VESSEL

CPT 92978: Intravascular Imaging and Interpretation for Coronary Vessel

92960-CARDIOVERSION-ELECTIVE-ELECTRICAL-CONVERSION-OF-ARRHYTHMIA

CPT 92960: Elective External Cardioversion for Cardiac Arrhythmias

CPT-92973-PERCUTANEOUS-CORONARY-MECHANICAL-THROMBECTOMY-ASPIRATION

CPT 92973: Percutaneous Coronary Mechanical Thrombectomy (Aspiration)

CPT-92953-CARDIAC-ELECTRICAL-STIMULATION-FOR-ARRHYTHMIA

CPT 92953: Cardiac Electrical Stimulation for Arrhythmia

CPT-92987-MITRAL-VALVULOPLASTY-BALLOON-DILATION

CPT 92987: Percutaneous Mitral Valvuloplasty (Balloon Dilation)

CPT-92971-LOWER-EXTREMITY-PNEUMATIC-COMPRESSION

CPT 92971: Lower Extremity Intermittent Pneumatic Compression

CPT-92970-AORTIC-BALLOON-CATHETER-CIRCULATORY-ASSIST

CPT 92970: Aortic Balloon-Tipped Catheter for Circulatory Assist

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Modifier	Description	When to Use
`11`	Provider billed is the usual/primary surgeon	Use when the reporting provider is the primary interventional cardiologist responsible for the procedure.
`22`	Increased procedural services	Use when work required to perform `92986` is substantially greater than typical (complex anatomy or prolonged procedure); documentation must support.
`23`	Unusual anesthesia	Use when general anesthesia is required for reasons unrelated to the procedure complexity (e.g., patient intolerance of conscious sedation).
`26`	Professional component	Use when reporting only the physician interpretation/physician component separate from facility technical services (rare for this procedure).
`52`	Reduced services	Use when the full procedure is not completed as planned (e.g., aborted after attempt due to access issues).
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances and should not be reported as full service.
`62`	Two surgeons/Co-surgeons	Use when two qualified physicians share equally in performing the procedure (uncommon for `92986`).
`66`	Surgical team	Use when a team approach is documented and required for the procedure.
`78`	Unplanned return to OR for related procedure following initial procedure	Use when the patient returns to the catheterization lab/operating room for a related complication of the valvuloplasty during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon is required and documented.
`81`	Minimum assistant surgeon	Use when a minimal level assistant surgeon participated and is eligible for billing.
`52`	Reduced services	Use when fewer services than described by the code were provided (duplicate entry for emphasis on applicability).
`QK`	Medical direction of 2–4 performers	Use when the reporting physician medically directs a team of qualified nonphysician anesthetists during related anesthesia services (if applicable).
`QX`	CRNA service furnished under the direction of an anesthesiologist	Use when a CRNA personally performs anesthesia under an anesthesiologist's direction for the procedure.

Taxonomy Code	Specialty	Notes
`207RC0000X`	Interventional Cardiology	Primary specialty performing balloon aortic valvuloplasty.
`207RI0010X`	Cardiology	General cardiologists may perform diagnostic evaluation and coordinate care.
`207RP1001X`	Cardiothoracic Surgery	May perform related surgical valve replacement or be involved if hybrid approach required.
`207LA0401X`	Vascular Surgery	May assist with complex vascular access or manage vascular complications.
`208600000X`	Anesthesiology	Provides sedation or general anesthesia during procedure when indicated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I35.0`	Nonrheumatic aortic (valve) stenosis	Primary indication for balloon aortic valvuloplasty to relieve stenosis-related obstruction.
`I35.2`	Nonrheumatic aortic (valve) stenosis with insufficiency	Relevant when mixed disease (stenosis with regurgitation) influences procedural risk and expected benefit.
`I24.9`	Acute myocardial ischemia, unspecified	May coexist or be evaluated prior to valvuloplasty if ischemic symptoms are present; coronary angiography often done.
`I50.9`	Heart failure, unspecified	Symptoms from aortic stenosis can precipitate heart failure; valvuloplasty may be performed for stabilization.
`R57.0`	Cardiogenic shock	Balloon aortic valvuloplasty can be used as an emergent temporizing measure in hemodynamically unstable patients.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`93458`	Catheter placement in coronary artery(s) for coronary angiography including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation	Often performed before `92986` to evaluate coronary anatomy and guide management if concurrent coronary disease is suspected.
`93618`	Right heart catheterization including measurement(s) of cardiac output and filling pressures	Performed in the same session to assess hemodynamics and guide decision-making for valvuloplasty in selected patients.
`37246`	Transcatheter placement of intravascular stent(s), may be performed for vascular access complications	Used when vascular complications from femoral access during `92986` require endovascular stent placement.
`33533`	Aortic valve replacement (AVR) with prosthesis, mechanical or tissue	Represents definitive surgical therapy often planned after balloon aortic valvuloplasty as bridge to surgery.
`33405`	Replacement, aortic valve, with cardiopulmonary bypass (AVR), complicated or repeat	Another surgical code denoting definitive surgical management following or instead of valvuloplasty in appropriate candidates.

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