In 2025, the 33361 cpt code continues to be essential for billing Transcatheter Aortic Valve Replacement (TAVR), also known as TAVI, using a percutaneous femoral approach. This article offers a detailed update on coding rules, payer-specific guidance, and best practices tailored for U.S. medical billing and coding professionals.
Overview: What Is CPT Code 33361?
The 33361 cpt code describes transcatheter aortic valve replacement performed via a percutaneous femoral artery approach :contentReference[oaicite:0]{index=0}. It includes all necessary catheterization, temporary pacing, contrast injection, fluoroscopic imaging supervision, and interpretation related to the procedure, which should not be billed separately when part of the primary service :contentReference[oaicite:1]{index=1}.
2025 Updates & Payer Guidance
Medicare (CMS)
For claims in calendar year 2025, CMS maintains national reimbursement at approximately $1,149 for facility services and RVUs of 35.51 total and 22.47 work RVUs for CPT code 33361 :contentReference[oaicite:2]{index=2}. Furthermore, Coverage with Evidence Development (CED) continues to apply, requiring registry participation and documentation when services are performed in clinical trials :contentReference[oaicite:3]{index=3}.
UnitedHealthcare Policy (Effective May 1, 2025)
UnitedHealthcare’s 2025 medical policy for transcatheter heart valve procedures continues to list CPT 33361 as the standard code for percutaneous femoral TAVR. The policy outlines alternative codes (33362–33369) for other access types and emphasizes that provider volume and evidence-based criteria must align with CMS coverage trends :contentReference[oaicite:4]{index=4}.
Impact on Billing Workflow
- Ensure documentation clearly indicates a percutaneous femoral approach: use exactly the language supporting 33361.
- Do not separately bill for included services such as pacing, imaging guidance, or catheterization when these occur as part of the TAVR procedure :contentReference[oaicite:5]{index=5}.
- Verify participation in CMS‑approved registries or trials if the service is under CED coverage; include trial codes or identifiers (e.g. Z00.6) on institutional claims :contentReference[oaicite:6]{index=6}.
Modifiers and Coding Nuances
Modifiers may be necessary depending on clinical circumstances:
- Modifier 22: Use if significantly increased procedural services were required.
- Modifier 59: Required when another distinct procedural service occurs on the same day.
- Modifier 62: For use when two surgeons performed separate substantive parts of the TAVR procedure.
Be cautious to avoid billing catheterization procedures separately if they are integral components of the primary 33361 procedure :contentReference[oaicite:7]{index=7}.
Best Practices for 2025 Coding
- Confirm use of the femoral artery approach; select code 33361 only for that approach.
- Include clinical trial identifiers or registry documentation when applicable.
- Review payer-specific policies (e.g. UnitedHealthcare, Anthem, Medicare Advantage) to validate coverage nuances.
- Ensure coding guidelines are followed for inclusion/exclusion of catheterization and imaging when bundled.
- Audit internal denial patterns: common denial reasons may include incorrect access code selection or missing modifiers.
Example Use Case
A high‑risk aortic stenosis patient undergoes TAVR via femoral access in March 2025. The facility bills 33361, documentation confirms access route and inclusion of imaging and pacing in the procedure. No separate billing for catheterization. Medicare processes as a bundled service. If the patient participates in a CMS‑approved trial, Z00.6 is included on the hospital claim form.
FAQ
Do I ever bill CPT 33361 with separate cath lab codes?
No. CPT 33361 bundles catheterization, temporary pacing, and imaging guidance into the TAVR procedure. Those should not be billed separately if performed for TAVR :contentReference[oaicite:8]{index=8}.
What if I performed TAVR via axillary or transapical access?
In those cases, do not use 33361. Instead use codes 33362 through 33366 per the specific approach: open femoral, axillary, iliac, or transapical routes supported in payer guidelines (Medicare and UnitedHealthcare) :contentReference[oaicite:9]{index=9}.
Conclusion
In 2025, CPT 33361 remains the standard code for percutaneous femoral TAVR procedures. Practitioners must follow Medicare CED rules, payer‑specific policies (like UnitedHealthcare’s), and ensure included services are not billed separately. With accurate documentation and appropriate modifier use, coding this procedure can proceed smoothly. Stay current with CMS updates and institutional coding guidance. For more coding guidance, explore our site’s other articles on claim denials and ICD‑10 coding tips.
If interested in related coding topics—such as common denial reasons, ICD‑10 coding tips, or prior authorization strategies—visit our resource page at cms1500claimbilling.com.
For official CMS coverage guidelines, see the CMS 2025 official guidelines. And consult UnitedHealthcare’s UnitedHealthcare policy for TAVR for payer‑specific rules.