Summary & Overview
CPT 33430: Mitral Valve Replacement with Cardiopulmonary Bypass
Headline: New overview of CPT 33430 — Mitral valve replacement with cardiopulmonary bypass
Lead: CPT 33430 codes for surgical replacement of the mitral valve performed with cardiopulmonary bypass, a high-acuity inpatient cardiovascular procedure with significant clinical and billing implications nationwide. This code is central to reimbursement and case-mix considerations for hospitals and cardiothoracic surgery programs.
What the code represents and why it matters: CPT 33430 denotes definitive surgical management for severe mitral valve disease when repair is not appropriate. As an inpatient, operating-room–based procedure, it drives resource use, length of stay, and quality reporting metrics. Accurate coding affects hospital reimbursement, quality measurement, and downstream care coordination for complex cardiac patients.
Key payers covered: This overview addresses coverage and billing considerations relevant to Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication summarizes clinical context for use of CPT 33430, contrasts it with related mitral and other valve procedures, outlines common billing themes such as procedural complexity and typical inpatient setting, and highlights where coding clarity is important for payers and providers. It also identifies areas where input data was not provided. Specific benchmarking, payer policy language, and line-item service metadata are covered in subsequent sections.
Data limitations: Data not available in the input for specific service-line metadata and payer-specific policy text.
CPT Code Overview
CPT 33430 describes replacement of the mitral valve performed with cardiopulmonary bypass. This procedure is a form of cardiothoracic surgery addressing diseased or dysfunctional mitral valves through excision and prosthetic valve implantation while the patient is supported by cardiopulmonary bypass.
Service Type: Cardiovascular / Cardiothoracic Surgery
Typical Site of Service: Hospital Inpatient (POS 21)
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with progressive mitral valve disease presents with severe symptomatic mitral regurgitation and/or mitral valve stenosis refractory to medical therapy. Preoperative workup includes transthoracic and transesophageal echocardiography demonstrating dysfunctional mitral leaflets with significant hemodynamic compromise, cardiac catheterization to assess coronary anatomy, and multidisciplinary evaluation by cardiology and cardiothoracic surgery. The patient is admitted to the hospital (inpatient) for planned mitral valve replacement under general anesthesia with cardiopulmonary bypass. Intraoperative workflow includes median sternotomy, institution of cardiopulmonary bypass, removal of the native mitral valve, implantation of a prosthetic valve, intraoperative transesophageal echocardiography confirmation of valve function, weaning from bypass, and transfer to the cardiac intensive care unit for postoperative monitoring and recovery.
Coding Specifications
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Modifier
22- Increased Procedural ServicesUse when the work required to perform
33430is substantially greater than typically required. Documentation must support the increased complexity, time, difficulty, or risk. -
Modifier
51- Multiple ProceduresUse when
33430is performed in conjunction with other distinct surgical procedures during the same operative session. Append modifier51according to payer rules when reporting multiple procedure reductions or bundling policies apply. -
Associated Provider Taxonomies and Specialties
| Taxonomy Code | Specialty |
|---|---|
208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
207RC0000X | Cardiovascular Disease Physician |
208600000X | Surgery Physician |
Related Diagnoses
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I35.0Nonrheumatic aortic (valve) stenosisAlthough an aortic valve diagnosis, this code can appear in patients with concomitant valvular disease; clinical relevance is assessment of multivalvular pathology when planning cardiac surgery including mitral valve replacement.
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I35.1Nonrheumatic aortic (valve) insufficiencyRepresents aortic regurgitation which may coexist with mitral disease; relevant when surgical strategy addresses multiple valve lesions.
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I35.2Nonrheumatic aortic (valve) stenosis with insufficiencyIndicates combined aortic valve dysfunction that may impact perioperative management when
33430is performed alongside interventions for aortic valve disease. -
I06.0Rheumatic aortic stenosisRheumatic involvement of the aortic valve may be present in patients with rheumatic heart disease affecting the mitral valve; relevant for surgical planning and intraoperative decisions.
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I06.2Rheumatic aortic stenosis with insufficiencyReflects rheumatic multivalvular disease with both stenosis and insufficiency of the aortic valve; clinically relevant when mitral valve replacement
33430is performed in the context of rheumatic heart disease.
Related CPT Codes
| CPT Code | Description | Clinical relationship to 33430 |
|---|---|---|
33427 | Annuloplasty (repair) of mitral valve, with cardiopulmonary bypass | Often an alternative when valve repair (annuloplasty) is feasible rather than full replacement; may be chosen intraoperatively if anatomy permits. |
33425 | Repair, mitral valve, with cardiopulmonary bypass | Alternative to 33430 when repair of mitral leaflets is possible; may be attempted before proceeding to replacement. |
33465 | Replacement, tricuspid valve, with cardiopulmonary bypass | May be performed concurrently when multivalve disease requires simultaneous tricuspid valve replacement during the same operative session; often reported in multi-procedure contexts where bundling rules apply. |
Common usage notes: codes 33425 and 33427 are commonly considered alternatives to 33430 when repair is possible. 33465 may be used together with 33430 in combined valve replacement procedures; modifier 51 may apply per payer policy.
National Reimbursement Benchmarks
Medicare mean allowed rate for 33430 is substantially lower than the BUCA (average commercial) mean rate; Medicare averages $2,635.24 versus BUCA at $3,623.85. This reflects the typical gap between Medicare reimbursement and commercial averages for this code.
Dispersion measured as the interquartile range (P75 − P25) varies across payers. UnitedHealth Group shows the widest spread (about $2,982.69), followed by Cigna (about $2,658.50) and Blue Cross Blue Shield (about $1,828.42). Medicare is the tightest (about $206.00), with Aetna and BUCA showing moderate dispersion (about $1,515.00 and $1,924.57, respectively). The table and chart below present the full numeric breakdown.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.