CPT code 33362: Open femoral TAVR billing guide

Key Takeaways

CPT code 33362 describes transcatheter aortic valve replacement (TAVR) performed through an open surgical exposure of the femoral artery, used when a percutaneous approach isn’t feasible.

The access route is the differentiator across the family: CPT 33361 covers percutaneous femoral access, while CPT 33362 covers the same femoral vessel accessed through a surgical cutdown.

Medicare coverage under NCD 20.32 requires a certified TAVR facility, an FDA-approved prosthetic valve, and a documented Heart Team evaluation before the procedure.

Pabau’s claims management software helps cardiovascular billing teams capture required documentation, apply correct modifiers, and reduce denials on complex structural heart procedure claims.

CPT Code 33362 is the procedure code for transcatheter aortic valve replacement (TAVR/TAVI) performed through an open surgical exposure of the femoral artery. Surgeons use this approach when calcification, vessel size, or tortuosity rules out the standard percutaneous femoral route covered by CPT 33361.

This guide covers the full descriptor, how 33362 differs from the rest of the 33361-33366 family, applicable ICD-10 codes, modifiers, Medicare NCD 20.32 requirements, current RVU values, and the denial patterns that trip up cardiovascular billing teams.

According to the American Medical Association (AMA), CPT codes are the authoritative standard for reporting medical procedures in the United States. CPT Code 33362 falls under Surgery > Cardiovascular System > Heart and Pericardium > Cardiac Valves > Aortic Valve > Transcatheter Aortic Valve Replacement, a section that requires careful code selection based on surgical access route.

CPT code 33362: Definition and full descriptor

CPT Code 33362 describes a specific procedure. The official AMA descriptor reads: Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery exposure. The descriptor limits this code to procedures where the surgeon performs a surgical cutdown to expose the femoral artery directly, rather than accessing it percutaneously through a needle puncture.

TAVR itself replaces a diseased aortic valve without open-heart surgery in the traditional sense. A prosthetic valve is delivered via catheter and expanded inside the existing valve. What distinguishes CPT Code 33362 from CPT 33361 is not the valve or the catheter but how the surgeon reaches the femoral artery: a surgical exposure versus a percutaneous puncture.

CPT code 33362 vs CPT 33361: The access approach difference

The most common coding error in the TAVR family is selecting 33361 when the case actually required an open surgical cutdown to the femoral artery. Both codes describe access through the same vessel; the differentiator is whether the surgeon punctured the artery percutaneously or exposed it surgically.

Selecting the wrong code means the billed procedure does not match the operative report, which triggers a denial or a post-payment audit.

When reviewing the operative report, look for explicit documentation of how the femoral artery was accessed. A percutaneous case describes needle puncture and closure-device deployment. An open case describes a groin incision, surgical dissection to expose the vessel, and a formal arteriotomy closure.

A case that starts percutaneous but converts to an open cutdown intraoperatively should be documented as such, since the final access technique determines the code.

Full CPT code family: 33361 through 33366

CPT Code 33362 belongs to a six-code TAVR family. Each code maps to a distinct access approach. Coders handling structural heart programs should keep this full reference table available, since the same patient may need a different access route across multiple procedures or revision encounters. See the AAPC CPT code lookup for the current descriptor text of each code in this family.

Verify the exact current descriptor for each code against the current AMA CPT codebook before billing, since access-approach terminology in this family is periodically refined. Many cardiovascular practices also handle other complex procedure coding families, including IVF CPT codes, which share a similar multi-code structure that requires careful approach-based selection.

Applicable ICD-10 diagnosis codes for CPT code 33362

TAVR procedures are performed on patients with severe valvular disease. Aortic stenosis is the primary driver, but the ICD-10-CM codes that support medical necessity under NCD 20.32 include several valvular pathologies. Coders should document the primary diagnosis as the condition directly necessitating the valve replacement, with secondary codes capturing comorbidities relevant to the risk stratification that the Heart Team documented.

Confirm current covered diagnoses against the active NCD 20.32 text at CMS.gov before billing. Coverage criteria can be updated, and using a diagnosis outside the currently covered list will result in a coverage denial regardless of whether the procedure was clinically appropriate. For ICD-10 crosswalk lookups, the AAPC crosswalk tool provides a useful reference for pairing procedure and diagnosis codes.

Modifiers for CPT code 33362

TAVR procedures typically involve a multidisciplinary surgical team. The modifier you apply depends on the physician’s role during the procedure and the payer’s specific rules. Medicare and commercial payers often differ on co-surgeon and assistant surgeon reimbursement for structural heart procedures, so verify modifier policy before submission.

Modifier -62 eligibility for CPT Code 33362 is payer-specific. Medicare permits co-surgeon billing when two distinct physician specialties are both required, but commercial payers may only allow one surgeon to bill. Always verify through the payer’s provider manual before submitting both claims.

Companion and add-on codes commonly billed with CPT code 33362

TAVR procedures almost always involve imaging guidance and monitoring services that can be billed separately from the primary surgical code. The Society for Cardiovascular Angiography and Interventions (SCAI) coding guidelines identify several companion codes relevant to TAVR cases regardless of access approach. Bundling rules apply, so confirm current CMS edits before submitting add-on codes alongside CPT Code 33362.

• CPT 93355 – Echocardiographic guidance for transcatheter aortic valve replacement (TAVR); includes all imaging performed during the procedure. This is the primary add-on code. Per SCAI guidelines, 93355 may be reported separately by the echocardiographer when a different physician provides the imaging guidance. Verify current CMS bundling edits before submitting.
• CPT 93306 – Transthoracic echocardiography; complete study. Report when a separate, complete echo is performed and documented outside the intraoperative guidance covered by 93355.
• CPT 71046 – Radiologic examination of the chest, 2 views. Often performed post-procedure for device position confirmation.
• CPT 75600 series – Aortography codes. May apply when fluoroscopic aortography is performed as a separate diagnostic service during the same session, subject to bundling rules.

Add-on code separability is one of the most audit-prone areas in TAVR billing. Practices handling complex cardiovascular procedure coding also benefit from understanding how similar multi-code families work across other specialties, such as ADHD screening CPT codes, where companion code bundling rules also require careful documentation.

Medicare coverage requirements: NCD 20.32 for CPT code 33362

Medicare does not cover TAVR procedures performed outside a narrow set of requirements established under National Coverage Determination (NCD) 20.32. Claims for CPT Code 33362 that do not meet every NCD criterion will be denied, regardless of how clinically appropriate the procedure was. The NCD 20.32 policy on the Medicare Coverage Database governs what qualifies.

Three requirements are absolute under NCD 20.32. First, the procedure must be performed at a hospital that CMS has certified as a TAVR facility. Second, the prosthetic valve used must carry FDA approval for the specific indication. Third, a formal multidisciplinary Heart Team must evaluate the patient before the procedure and document that evaluation in the medical record.

• Certified TAVR facility – The hospital must hold current CMS certification. Billing from a non-certified facility is the single largest denial category for TAVR claims. Verify certification status before scheduling the procedure, not after.
• FDA-approved device – The specific prosthetic valve brand and model must have FDA approval for the patient’s indication. Not all TAVR valves are approved for all valve sizes or pathologies.
• Heart Team evaluation – A formal written evaluation by a multidisciplinary team (at minimum a cardiac surgeon and an interventional cardiologist) must be in the medical record. The team must have agreed on TAVR as the appropriate treatment modality.
• Patient risk documentation – Risk stratification scores (STS score, Frailty Index, or equivalent) must be documented. NCD 20.32 ties coverage to defined high-risk, extreme-risk, or intermediate-risk classifications depending on the indication.
• Data registry participation – CMS requires facilities to submit procedure data to an approved national registry (typically TVT Registry). Non-submission can affect future coverage and certification status.

Documentation requirements for billing CPT code 33362

A clean CPT Code 33362 claim rests on documentation that confirms access approach, medical necessity, facility eligibility, and Heart Team consensus. Missing any of these four elements invites a denial or a pre-payment review request.

Cardiovascular billing teams should build a documentation checklist for every TAVR case before the claim leaves the department. Using digital intake forms alongside a structured client information template streamlines the collection of required documentation across the care team.

• Operative report – Must explicitly identify the femoral access technique (percutaneous or open surgical cutdown), the vessel exposure and closure method, the prosthetic valve brand/model/size, and any complications encountered.
• Heart Team evaluation report – A dated, signed document from the multidisciplinary team. Must confirm team composition, decision rationale, and the clinical basis for choosing TAVR over surgical aortic valve replacement (SAVR).
• Patient risk stratification – STS Predicted Risk of Mortality score or equivalent, documented in the pre-procedure assessment. The specific risk category (high, extreme, or intermediate risk) must align with the NCD coverage criteria for the indication billed.
• Echocardiography reports – Pre-procedure echo confirming aortic valve area, mean gradient, and valve morphology. Post-procedure echo if 93355 is billed separately.
• Implant data – Device sticker or procedural record identifying the specific prosthetic valve implanted, with FDA approval reference for that device.
• Place of service – Claim must reflect POS 21 (Inpatient Hospital) for standard TAVR admissions. Confirm with payer if the procedure was performed in a hybrid OR under outpatient status, as some payers have updated their POS requirements.

The Heart Team evaluation report is the single most commonly missing document when a CPT Code 33362 claim is denied. It is not enough for the evaluation to have occurred; the written report must be retrievable in the medical record at the time of claim submission.

For practices managing documentation across multiple care sites, structured medical forms workflows and consistent nursing documentation habits help ensure this kind of record is captured and stored before the billing team submits the claim.

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Reimbursement rates and RVU values for CPT code 33362

CPT Code 33362 is a high-complexity surgical code carrying substantial relative value unit (RVU) weight. Under the CY2026 Medicare Physician Fee Schedule final rule (CMS-1832-F), the code carries a work RVU of 23.93 and a national facility payment of $1,176. These are unadjusted national averages; actual payment varies by geographic locality.

Use the CMS Physician Fee Schedule lookup tool to check the adjusted rate for a specific locality before posting an expected reimbursement figure.

CPT Code 33362 carries a 0-day global period, so there is no bundled post-operative window the way there is with 10-day or 90-day global codes. Post-operative visits beyond the day of the procedure are billed separately without needing modifier -24.

A significant, separately identifiable E/M service performed by the same physician on the same day as the procedure still needs modifier -25 to be paid separately. Co-surgeons billing with modifier -62 each receive approximately 62.5% of the total allowable, not the full amount independently.

Common denial reasons and how to avoid them

TAVR claims are among the most scrutinized in cardiovascular billing. The combination of high dollar value, strict Medicare criteria, and multidisciplinary documentation requirements creates multiple points of failure. The five denial patterns below account for the majority of rejected CPT Code 33362 claims based on Novitas Solutions Medicare claim submission guidance.

• Missing Heart Team evaluation report – The most frequent denial. The evaluation must be a written, dated, signed document in the medical record. A verbal team consensus or a brief note in the progress record does not satisfy NCD 20.32. Solution: build a Heart Team documentation template that captures all required elements and make chart completion a prerequisite for claim submission.
• Non-certified facility – Claims from hospitals without active CMS TAVR certification are denied at the coverage level, not the coding level. No appeal succeeds for this denial. Solution: verify certification annually and confirm status before scheduling high-risk patients for TAVR.
• Wrong access approach code – Submitting 33361 for a case that required an open surgical cutdown, or 33362 for a case where percutaneous femoral access was used throughout, creates a mismatch between the billed code and the operative report. Payers catching this in a post-payment audit may seek full recoupment. Solution: require coders to confirm the access technique in the operative report before code assignment.
• Missing risk stratification documentation – NCD 20.32 ties coverage to specific patient risk categories. An STS score or equivalent risk tool must be in the chart. Solution: confirm risk stratification completion as part of the pre-procedure checklist, not as a retrospective documentation task.
• Add-on code denied due to bundling – CPT 93355 submitted without separate echocardiographer documentation, or without confirming that a different physician performed the imaging guidance, will be bundled into the primary code. Solution: require a separate operative note from the echocardiographer for every case where 93355 is billed.

Practices using structured automated billing workflows can embed documentation checkpoints directly into the claim preparation process, flagging incomplete records before submission rather than after denial. This approach is particularly effective for high-value codes like CPT Code 33362 where a single denied claim represents significant lost revenue.

How Pabau supports cardiovascular billing workflows

CPT Code 33362 is not a code that tolerates incomplete workflows. The NCD requirements, the multi-physician team structure, and the strict Medicare documentation rules all create dependencies that a manual billing process handles poorly at scale. Cardiovascular practices billing TAVR procedures regularly need systems that capture structured documentation, track modifier assignments, and surface claim errors before submission.

Pabau’s claims management software helps cardiovascular teams build procedure-specific documentation checklists, assign modifier rules to complex codes, and maintain the audit trail required for NCD 20.32 compliance.

For practices managing multi-physician teams on high-value surgical cases, the platform’s ability to capture discrete documentation fields from each provider reduces the manual reconciliation that typically precedes claim submission. Many practices exploring practice management software find that integrating claims management with scheduling and documentation in one system reduces the pre-submission review burden.

The referring physicians behind a TAVR workup range from primary care practices monitoring long-term cardiovascular risk to longevity clinics tracking preventive heart health markers, and all of them need documentation that hands off cleanly to the surgical team.

Practices also benefit from structured approaches to managing complex billing codes across specialties. The Bupa CCSD codes reference illustrates how multi-code families with payer-specific rules require the same documentation-first approach that TAVR billing demands.

Coding uncertainty isn’t unique to cardiology. The coaching CPT codes reference shows how other procedure-specific billing guides reduce ambiguity across service lines, the same principle behind resources like the chiropractic billing cheat sheet for practices juggling several code families at once.

For practices managing HIPAA-compliant documentation workflows across a cardiovascular program, HIPAA compliance software outlines the documentation and access control requirements that apply when storing sensitive procedure records electronically. Effective billing starts with secure, structured documentation capture, and the same systems that protect patient data also support clean claim submission for high-value codes like CPT Code 33362.

Conclusion

CPT Code 33362 demands precision at every stage: confirming the femoral access technique before coding, verifying NCD 20.32 eligibility before billing, and securing the Heart Team evaluation report before submission. Most denials on this code are preventable with the right pre-submission checklist in place.

Pabau’s claims management software gives cardiovascular billing teams the structured documentation and workflow tools to submit cleaner claims on complex codes. To see how Pabau handles cardiovascular billing workflows, book a demo with the team.

Continue your research

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