This section contains information to assist providers in billing for surgical procedures related to the cardiovascular system. 
 
 

Complex Venipunctures: CPT-4 code 36410 may be used to bill non-routine venipunctures

Age Restrictions for recipients 3 years of age or older.  Anesthesiology services and assistant surgeon services are not payable for this procedure. 
 

Complex venipunctures for recipients younger than 3 years of age are reimbursable with CPT-4 codes 36400 and 36405.  Code 36400 is for billing complex venipuncture using the femoral vein or jugular vein and code 36405 is for billing complex venipuncture using the scalp vein.  Assistant surgeon services are not payable for this procedure. 
 

Note: Reimbursement for routine venipuncture is included in the reimbursement for laboratory procedures and is not separately reimbursable. 
 
 
 

Implantable Infusion CPT-4 codes 36260 – 36262 are billed for inserting, revising and

Pump Codes removing implanted infusion pumps.  These codes are restricted to procedures for placement of intra-arterial catheters for regional chemotherapy.  CPT-4 code 36260 (insertion of implantable  
intra-arterial infusion pump) requires a Treatment Authorization Request (TAR).  A TAR is UnotU required for the following codes: 
 

UCPT-4 CodeU UDescriptionU

36261 Revision of implanted intra-arterial infusion pump

36262 Removal of implanted intra-arterial infusion pump 
 
 
 

Placement of CPT-4 code 33886 (placement of distal extension prosthesis) may be

Distal Prosthesis reimbursed only once per day, any provider.  Reimbursement for

CPT-4 code 75959 (placement of distal extension prosthesis, radiological supervision and interpretation) is limited to once per date of service, regardless of the number of modules deployed. 
 
 
 

Repair of CPT-4 codes 33925 and 33926 (repair of pulmonary artery) are

Pulmonary Artery reimbursable for a second assistant surgeon. 
 
 

Septal Defect and  CPT-4 codes 33675 – 33677 (closure of septal defect), 33724 and

Venous Anomalies 33726 (repair of venous anomalies) are reimbursable for a second assistant surgeon. 
 
 

Venous Catheter To bill for the surgical placement of intravenous devices for recipients who need repeated intravenous administration of drugs and related substances, use CPT-4 codes 36560 – 36566, 36570 and 36571 (insertion of central venous access device). 
 

The placement of a reservoir (for example, Porta-Cath, Infus-a-Port) is considered incidental and is not reimbursable as an additional procedure.

Simple Cutdown Placement Providers billing for the simple cutdown placement of central  
venous catheters (for example, for central venous pressure, hyperalimentation, hemodialysis or chemotherapy) should use  
CPT-4 codes 36555, 36557 or 36568 for recipients under 5 years of age and codes 36556, 36558 or 36569 for recipients age 5 years or older.

Billing Requirements CPT-4 code 36598 (contrast injection[s] for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report) may be split-billed, and must be billed with the appropriate modifier (26, 99, TC or ZS). 
 
 
 

Coronary Artery Bypass When a coronary bypass procedure is performed using venous grafts and arterial grafts during the same operating session, bill the procedure using UtwoU surgical codes:

• The appropriate arterial graft code (CPT-4 codes 
  33533 – 33536) with modifier AG
• The appropriate combined arterial-venous graft code  
  (CPT-4 codes 33517 – 33519, 33521 – 33523) with modifier 51

These codes require an approved TAR. 
 
 
 

Percutaneous Transluminal Refer to the Cardiology section in this manual for coverage

Coronary Balloon and billing information.

Angioplasty

Re-Operation: A coronary artery bypass or valve re-operation (CPT-4 code 33530) is

Reimbursement Restrictions reimbursable only if the re-operation was performed more than one month after the original operation.  The re-operation (code 33530) should be billed in addition to the code for the primary procedure (codes 33400 – 33478, 33510 – 33523, 33533 – 33536) on the same claim form.

Providers billing with code 33410 (replacement, aortic valve, with cardiopulmonary bypass; with stentless tissue valve) may be reimbursed for a second assistant surgeon.

Low-density  Low-density lipoprotein (LDL)-apheresis is reimbursable when

Lipoprotein-Apheresis  performed to remove low-density lipoprotein cholesterol (LDL-C) from the plasma of high-risk patients when diet has been ineffective and maximum drug therapy has either been ineffective or not tolerated.  The following recipients may be approved for LDL-apheresis:

• Recipients with homozygous familial hypercholesterolemia (FH) with LDL-C levels greater than 500 mg/dL
• Recipients with heterozygous FH with LDL-C levels greater than 300 mg/dL
• Recipients with heterozygous FH with LDL-C levels greater than 200 mg/dL and documented coronary artery disease

Authorization Authorization is required for LDL-apheresis.  TARs must be submitted

each year for LDL-apheresis and may be approved for continuous  
7 to 14-day intervals.  All TARs must have a treatment plan that includes frequency and duration of proposed treatments.  The initial TAR must include the following medical documentation:

• Diagnosis of familial hypercholesterolemia FH must be demonstrated by clinical assessment or by special laboratory examination.
• LDL-C levels must be obtained:

• After the recipient with homozygous FH has been on an American Heart Association Step II Diet or an equivalent diet for at least three months or the recipient with heterozygous FH has been on a diet for six months, Uand

• While the recipient is on a maximum tolerated combination drug therapy from at least two separate classes of hypolipidemic agents, one of which must include a 
  3-Hydroxy-3-methyl-glutaryl-Coenzyme A (HMG-CoA) reductase inhibitor.
• Two LDL-C levels must be obtained within a 2 to 4-week period.

• Coronary artery disease must be documented by coronary angiography, history of myocardial infarction, history of Coronary Artery Bypass Graft surgery (CABG), Percutaneous Transluminal Coronary Angioplasty (PTCA) or an alternative revascularization procedure such as atherectomy or stent, or by progressive angina documented by exercise or pharmacologic stress test for patients with heterozygous FH with LDL-C levels greater than 200 mg/dL

Reauthorization Requirements TARs for reauthorization must include the following medical documentation:

• Pre- and post-treatment cholesterol levels for at least two consecutive months prior to the submission date of the TAR
• The post-treatment cholesterol levels should, at a minimum, be at least 50 percent less than the pre-treatment level

Billing Requirements Providers should bill for LDL-apheresis using CPT-4 code 36516 (therapeutic apheresis; with extracorporeal selective adsorption or filtration and plasma reinfusion).  Reimbursement for code 36516 includes pre-and post-cholesterol levels.

Cardiac Implantable Hospital outpatient departments and outpatient surgery clinic

Devices and Stents providers only may bill the following HCPCS codes for cardiac implantable devices and stents.

Providers must bill the HCPCS codes for cardiac implantable devices in conjunction with ICD-9-CM diagnosis codes 398 – 429.9 and submit an invoice.  Failure to submit an invoice will result in denial of the claim.

Providers must bill the following HCPCS codes for stents in conjunction with ICD-9-CM diagnosis codes 410 – 429.9 and submit an invoice.  Failure to submit an invoice will result in denial of the claim.

Note: For invoice requirements, refer to the “Surgical Implantable

Device Reimbursement” subsection in the Surgery section in the appropriate Part 2 manual.

Frequency Restriction Cardiac implantable devices and stents have a frequency restriction of once a year for the same recipient by the same provider.  Medical

justification documented in the Remarks field (Box 80) is required

for any surgical implantable device claims billed more than once in a year.

Second Assistant Surgeon Reimbursement for a second assistant surgeon is allowed for the following CPT-4 codes:

32852, 32854 33031, 33120, 33251, 33259, 33261, 33305, 33315, 33321, 33322, 33332, 33335, 33400, 33403, 33405, 33406,  
33410 – 33412, 33415 – 33417, 33422, 33425  – 33427, 33430, 33460, 33465, 33468, 33474, 33476, 33478, 33496, 33500, 33504, 33510 – 33514, 33516 – 33519, 33521 – 33523, 33530,  
33533 – 33536, 33542, 33545, 33572, 33641, 33645, 33647, 33660, 33665, 33670, 33675 – 33677, 33681, 33684, 33688, 33692, 33694, 33702, 33710, 33720, 33724, 33726, 33730, 33736, 33774 – 33781, 33786, 33788, 33814, 33840, 33845, 33851 – 33853, 33860, 33861 33863, 33864, 33870, 33875, 33877, 33910, 33916, 33922, 33925, 33926, 33945, 35081, 35082, 35091, 35092, 35103, 35211, 35241, 35271, 35331, 35361, 35363, 35526, 35531, 35548, 35549, 35551, 35560, 35626, 35631, 35646, 35651

Providers must document in the Remarks field (Box 80)/Reserved for Local Use field (Box 19) of the claim that the services were rendered by more than one assistant surgeon for the same surgery on the same date.

Low-density Lipoprotein- Low-density lipoprotein (LDL)-apheresis is reimbursable when

Apheresis  performed to remove low-density lipoprotein cholesterol (LDL-C) from the plasma of high-risk patients when diet has been ineffective and maximum drug therapy has either been ineffective or not tolerated.  The following recipients may be approved for LDL-apheresis:

• Recipients with homozygous familial hypercholesterolemia (FH) with LDL-C levels greater than 500 mg/dL
• Recipients with heterozygous FH with LDL-C levels greater than 300 mg/dL
• Recipients with heterozygous FH with LDL-C levels greater than 200 mg/dL and documented coronary artery disease

Prior Authorization Prior authorization is required for LDL-apheresis.  TARs must be submitted each year for LDL-apheresis and may be approved for continuous 7- to 14-day intervals.  All TARs must have a treatment plan that includes frequency and duration of proposed treatments.  The initial TAR must include the following medical documentation:

• Diagnosis of familial hypercholesterolemia FH must be demonstrated by clinical assessment or by special laboratory examination
• LDL-C levels must be obtained:

• After the recipient with homozygous FH has been on an American Heart Association Step II Diet or an equivalent diet for at least three months or the recipient with heterozygous FH has been on a diet for six months, Uand

• While the recipient is on a maximum tolerated combination drug therapy from at least two separate classes of hypolipidemic agents, one of which must include a 
  3-Hydroxy-3-methyl-glutaryl-Coenzyme A (HMG-CoA) reductase inhibitor
• Two LDL-C levels must be obtained within a 2- to 4-week period

• Coronary artery disease must be documented by coronary angiography, history of myocardial infarction, history of Coronary Artery Bypass Graft surgery (CABG), Percutaneous Transluminal Coronary Angioplasty (PTCA) or an alternative revascularization procedure such as atherectomy or stent, or by progressive angina documented by exercise or pharmacologic stress test for patients with heterozygous FH with LDL-C levels greater than 200 mg/dL

Reauthorization Requirements TARs for reauthorization must include the following medical documentation:

• Pre- and post-treatment cholesterol levels for at least two consecutive months prior to the submission date of the TAR
• The post-treatment cholesterol levels should, at a minimum, be at least 50 percent less than the pre-treatment level

Billing Requirements Providers should bill for LDL-apheresis using CPT-4 code 36516 (therapeutic apheresis; with extracorporeal selective adsorption or filtration and plasma reinfusion).  Reimbursement for code 36516 includes pre-and post-cholesterol levels.

Cardiac Implantable Hospital outpatient departments and outpatient surgery clinic

Devices and Stents providers only may bill the following HCPCS codes for cardiac implantable devices and stents.

Providers must bill the HCPCS codes for cardiac implantable devices in conjunction with ICD-9-CM diagnosis codes 398 – 429.9 and submit an invoice.  Failure to submit an invoice will result in denial of the claim.

Providers must bill the following HCPCS codes for stents in conjunction with ICD-9-CM diagnosis codes 410 – 429.9 and submit an invoice.  Failure to submit an invoice will result in denial of the claim.

Note: For invoice requirements, refer to the “Surgical Implantable

Device Reimbursement” subsection in the Surgery section in the appropriate Part 2 manual.

Frequency Restriction Cardiac implantable devices and stents have a frequency restriction of once a year for the same recipient by the same provider.  Medical

justification documented in the Remarks field (Box 80) is required

for any surgical implantable device claims billed more than once in a year.

Second Assistant Surgeon Reimbursement for a second assistant surgeon is allowed for the following CPT-4 codes:

32852, 32854 33031, 33120, 33251, 33259, 33261, 33305, 33315, 33321, 33322, 33332, 33335, 33400, 33403, 33405, 33406,  
33410 – 33412, 33415 – 33417, 33422, 33425  – 33427, 33430, 33460, 33465, 33468, 33474, 33476, 33478, 33496, 33500, 33504, 33510 – 33514, 33516 – 33519, 33521 – 33523, 33530,  
33533 – 33536, 33542, 33545, 33572, 33641, 33645, 33647, 33660, 33665, 33670, 33675 – 33677, 33681, 33684, 33688, 33692, 33694, 33702, 33710, 33720, 33724, 33726, 33730, 33736, 33774 – 33781, 33786, 33788, 33814, 33840, 33845, 33851 – 33853, 33860, 33861 33863, 33864, 33870, 33875, 33877, 33910, 33916, 33922, 33925, 33926, 33945, 35081, 35082, 35091, 35092, 35103, 35211, 35241, 35271, 35331, 35361, 35363, 35526, 35531, 35548, 35549, 35551, 35560, 35626, 35631, 35646, 35651

Providers must document in the Remarks field (Box 80)/Reserved for Local Use field (Box 19) of the claim that the services were rendered by more than one assistant surgeon for the same surgery on the same date.