CPT 99190 Perfusion Pump Reimbursement | OpenPayer

Summary & Overview

CPT 99190: Perfusion Pump–Oxygenator Operation, Hourly

CPT code 99190 denotes the hourly assembly and operation of a mechanical pump–oxygenator or heat exchanger for extracorporeal circulation and oxygenation of blood, a critical perfusion service used during cardiac surgeries requiring cardiopulmonary bypass. Nationally, this code captures a specialized intraoperative activity that directly supports complex cardiac procedures and resource-intensive perioperative care. Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, how it fits into the clinical workflow for cardiac surgery, and the typical site of service. The publication outlines payer coverage considerations, common modifiers associated with the service (listed elsewhere), and operational benchmarks where available. It also summarizes coding context relevant to hospital billing and perfusion service documentation and highlights areas where policy updates or payer-specific rules may affect claim processing. Data not available in the input is identified as such in relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare99190CPTperfusioncardiac surgerycardiopulmonary bypassoperating roomblood oxygenationpump oxygenator

Billing Code Overview

CPT code 99190 describes the assembly and operation of a mechanical pump–oxygenator or heat exchanger to circulate and oxygenate blood outside the body. The service is reported on an hourly basis and may include monitoring of blood pressure and performing an electrocardiogram as part of the procedure. This activity supports cardiopulmonary bypass during cardiac surgical procedures.

Service type: Perfusion service involving preparation and operation of extracorporeal circulation equipment
Typical site of service: Inpatient operating room or other surgical suite where cardiac surgery with cardiopulmonary bypass is performed

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with severe multivessel coronary artery disease is scheduled for elective coronary artery bypass grafting (CABG) with cardiopulmonary bypass. In the preoperative holding area the perfusion team assembles and primes the heart–lung machine (pump–oxygenator and heat exchanger), verifies circuit integrity, calibrates flow and pressure monitoring, and performs a functional test run. Intraoperatively, a certified perfusionist operates the mechanical pump–oxygenator to provide extracorporeal circulation and blood oxygenation while the surgeon arrests the heart and performs coronary anastomoses. The perfusionist monitors pump flows, arterial and venous pressures, gas exchange, temperatures, and may record continuous ECG and arterial pressure tracings. Billing is captured per hour of pump operation using 99190. Typical site of service is the hospital operating room during cardiac surgery; this may also occur in an ambulatory surgical center equipped for cardiac procedures or a hybrid cardiac catheterization suite when extended extracorporeal support is required.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	Use when two surgeons work together as primary surgeons during the cardiac procedure while extracorporeal circulation is provided.

CPT 99184: Neonatal Therapeutic Hypothermia with Esophageal Temperature Monitoring

CPT-99199-UNLISTED-MEDICINE-SERVICE-PROCEDURE

CPT 99199: Unlisted Medicine Service or Procedure

CPT-99195-THERAPEUTIC-PHLEBOTOMY-BLOOD-REMOVAL

CPT 99195: Therapeutic Phlebotomy for Blood Component Reduction

CPT-99173-PEDIATRIC-VISUAL-ACUITY-SCREENING

CPT 99173: Pediatric Visual Acuity Screening

CPT-99177-INSTRUMENT-VISION-SCREENING-BOTH-EYES

CPT 99177: Instrument-Based Vision Screening and Analysis, Both Eyes

CPT-99170-FORENSIC-PEDIATRIC-SEXUAL-ABUSE-EXAM-MICROSCOPY

CPT 99170: Forensic Pediatric Sexual Abuse Examination with Microscopy

CPT-99188-FLUORIDE-ADHESIVE-APPLICATION-TOOTH-SURFACE

CPT 99188: Fluoride Adhesive Application to Tooth Surface

CPT-99191-PUMP-OXYGENATOR-EXTRACORPOREAL-CIRCULATION-45MIN

CPT 99191: Pump–Oxygenator/Heat Exchanger Operation, 45 Minutes

CPT-99175-EMETIC-ADMINISTRATION-FOR-INGESTED-POISONING

CPT 99175: Emetic Administration for Ingested Poisoning

CPT-99172-FUNCTIONAL-VISION-ASSESSMENT-JOB-FITNESS

CPT 99172: Functional Vision Assessment for Job Fitness

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Taxonomy Code	Specialty	Notes
`225100000X`	Cardiovascular Perfusionist	Primary specialty responsible for operation of pump–oxygenator and circuit management.
`2080P0200X`	Cardiothoracic Surgery	Surgeons performing CABG and other cardiac operations that require cardiopulmonary bypass.
`2086S0127X`	Cardiology - Interventional	Cardiologists in hybrid procedures where extracorporeal circulation may be used during structural interventions.
`367A00000X`	Anesthesiology	Cardiac anesthesiologists coordinating hemodynamic monitoring and anesthesia management during bypass procedures.
`364S00000X`	Physician Assistant	Advanced practice providers who may assist in perioperative care and documented assistant roles.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Coronary artery disease leading to CABG with cardiopulmonary bypass support.
`I21.3`	ST elevation (STEMI) myocardial infarction of other anterior wall	Acute MI requiring surgical revascularization where rapid extracorporeal support may be used.
`I35.0`	Nonrheumatic aortic (valve) stenosis	Severe aortic stenosis requiring valve replacement with cardiopulmonary bypass.
`I42.0`	Dilated cardiomyopathy	Advanced cardiomyopathy patients may require surgical procedures utilizing extracorporeal circulation.
`Q21.1`	Atrial septal defect	Congenital cardiac repairs often performed on cardiopulmonary bypass.
`T82.7XXA`	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter	Reoperative cardiac procedures to address device complications frequently use bypass and perfusion services.
`I50.9`	Heart failure, unspecified	Severe heart failure cases may undergo surgical interventions necessitating pump–oxygenator support.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33405`	Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve	Performed with cardiopulmonary bypass; `99190` documents perfusion time for bypass during valve replacement.
`33533`	Coronary artery bypass, single arterial graft; with cardiopulmonary bypass	CABG procedures commonly require pump–oxygenator; `99190` billed per hour of extracorporeal support.
`33967`	Cardiopulmonary bypass, extracorporeal circulation, with pump oxygenator; including monitoring, per hour	Closely related code describing extracorporeal circulation technical services; used in conjunction or as reference for perfusion services timing.
`93798`	Noninvasive hemodynamic monitoring (eg, cardiac output)	Intraoperative monitoring that may supplement perfusionist documentation; performed alongside pump operation.
`99291`	Critical care, evaluation and management of the critically ill patient; first 30–74 minutes	Postoperative critical care for a patient who remains unstable after bypass; temporally related in the perioperative workflow.

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