New 2022 codes for Exchange plans and commercial plans
Updated Sept. 2022: This article has been updated with new codes
Beginning Jan. 1, 2022, there are new Current Procedural Terminology (CPT®) codes in place for congenital heart disease:
Affected States
These CPT code changes affect all commercial plans and UnitedHealthcare Individual Exchange plans, also referred to as Individual and Family, plans in the following states:
The new codes and their descriptions are listed below.
Cardiac catheterization for congenital defects CPT codes
| CPT code | Code description |
|---|---|
| 93593 | Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections |
| 93594 | Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; abnormal native connections |
| 93595 | Left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections |
| 93596 | Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); abnormal native connections |
| 93597 | Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); abnormal native connections |
| 93598 | Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of congenital heart defects (List separately in addition to code for primary procedure) |
Endovascular repair of congenital heart and vascular defects CPT codes
| CPT code | Code description |
|---|---|
33894 |
Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches |
| 33895 | Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; not crossing major side branches |
| 33897 | Percutaneous transluminal angioplasty of native or recurrent coarctation of the aorta |
CPT codes to be added to UnitedHealthcare commercial plans
| CPT code | Code description |
|---|---|
| 93582 | Percutaneous transcatheter closure of patent ductus arteriosus |
| 33250 | Operative ablation of supraventricular arrhythmogenic focus or pathway (eg, Wolff-Parkinson-White, atrioventricular node re-entry), tract(s) and/or focus (foci); without cardiopulmonary bypass |
| 33253 | Operative incisions and reconstruction of atria for treatment of atrial fibrillation or atrial flutter (eg, maze procedure) |
| 33468 | Tricuspid valve repositioning and plication for Ebstein anomaly |
| 33390 | Valvuloplasty, aortic valve; open, with cardiopulmonary bypass |
| 33391 | Valvuloplasty, aortic valve; open, with cardiopulmonary bypass |
| 93583 | Percutaneous transcatheter septal reduction therapy (eg, alcohol septal ablation) including temporary pacemaker insertion when performed |
| 33620 | Application of right and left pulmonary artery bands (eg, hybrid approach stage 1) |
| 33622 | Reconstruction of complex cardiac anomaly (eg, single ventricle or hypoplastic left heart) with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of cavopulmonary anastomosis, and removal of right and left pulmonary bands (eg, hybrid approach stage 2, Norwood, bidirectional Glenn, pulmonary artery debanding) |
| 33782 | Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, Nikaidoh procedure); without coronary ostium reimplantation |
| 33783 | Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, Nikaidoh procedure); with reimplantation of 1 or both coronary ostia |
| 33925 | Repair of pulmonary artery arborization anomalies by unifocalization; without cardiopulmonary bypass |
| 33926 | Repair of pulmonary artery arborization anomalies by unifocalization; with cardiopulmonary bypass |
| 33465 | Replacement, tricuspid valve, with cardiopulmonary bypass |
| 33472 | Valvotomy, pulmonary valve, open heart; with inflow occlusion |
| 33722 | Closure of aortico-left ventricular tunnel |
| 33813 | Obliteration of aortopulmonary septal defect; without cardiopulmonary bypass |
| 33814 | Obliteration of aortopulmonary septal defect; with cardiopulmonary bypass |
| 33824 | Repair of patent ductus arteriosus; by division, 18 years and older |
| 33741 | Transcatheter atrial septostomy (TAS) for congenital cardiac anomalies to create effective atrial flow, including all imaging guidance by the proceduralist, when performed, any method (eg, Rashkind, Sang-Park, balloon, cutting balloon, blade) |
| 33745 | Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catherization for congenital cardiac anomalies, and target zone angioplasty, when performed (eg, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles); initial intracardiac shunt |
| 33746 | Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catherization for congenital cardiac anomalies, and target zone angioplasty, when performed (eg, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles); each additional intracardiac shunt location (List separately in addition to code for primary procedure) |
ICD 10 diagnosis codes to be added to UnitedHealthcare commercial plans
| ICD 10 CM Diagnosis code | Code description |
|---|---|
| Q25.21 | Interruption of aortic arch |
| Q25.29 | Other atresia of aorta |
| Q25.41 | Absence and aplasia of aorta |
| Q25.42 | Hypoplasia of aorta |
| Q25.43 | Congenital aneurysm of aorta |
| Q25.44 | Congenital dilation of aorta |
| Q25.45 | Double aortic arch |
| Q25.46 | Tortuous aortic arch |
| Q25.47 | Right aortic arch |
| Q25.48 | Anomalous origin of subclavian artery |
| Q25.49 | Other congenital malformations of aorta |
| I27.83 | Eisenmenger's syndrome |
CPT codes to be added to Individual Exchange plans
| CPT code | Description |
|---|---|
| 93582 | Percutaneous transcatheter closure of patent ductus arteriosus |
| 33202 | Lead and Dual chamber pacemaker implantation |
| 33213 | Lead and Dual chamber pacemaker implantation |
| 33253 | Operative incisions and reconstruction of atria for treatment of atrial fibrillation or atrial flutter (eg, maze procedure) |
| 33468 | Tricuspid valve repositioning and plication for Ebstein anomaly |
| 33390 | Valvuloplasty, aortic valve; open, with cardiopulmonary bypass |
| 33391 | Valvuloplasty, aortic valve; open, with cardiopulmonary bypass |
| 93580 | Percutaneous transcatheter closure of congenital interatrial communication (ie, Fontan fenestration, atrial septal defect) with implant |
| 93583 | Percutaneous transcatheter septal reduction therapy (eg, alcohol septal ablation) including temporary pacemaker insertion when performed |
| 33620 | Application of right and left pulmonary artery bands (eg, hybrid approach stage 1) |
| 33622 | Reconstruction of complex cardiac anomaly (eg, single ventricle or hypoplastic left heart) with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of cavopulmonary anastomosis, and removal of right and left pulmonary bands (eg, hybrid approach stage 2, Norwood, bidirectional Glenn, pulmonary artery debanding) |
| 33925 | Repair of pulmonary artery arborization anomalies by unifocalization; without cardiopulmonary bypass |
| 33926 | Repair of pulmonary artery arborization anomalies by unifocalization; with cardiopulmonary bypass |
| 33465 | Replacement, tricuspid valve, with cardiopulmonary bypass |
| 33472 | Valvotomy, pulmonary valve, open heart; with inflow occlusion |
| 33813 | Obliteration of aortopulmonary septal defect; without cardiopulmonary bypass |
| 33814 | Obliteration of aortopulmonary septal defect; with cardiopulmonary bypass |
| 33824 | Repair of patent ductus arteriosus; by division, 18 years and older |
ICD 10 diagnosis codes to be added to Individual Exchange plans
| ICD 10 CM Diagnosis code | Description |
|---|---|
| Q20.0 | Common arterial trunk |
| Q20.1 | Double outlet right ventricle |
| Q20.2 | Double outlet left ventricle |
| Q20.3 | Discordant ventriculoarterial connection |
| Q20.4 | Double inlet ventricle |
| Q20.5 | Discordant atrioventricular connection |
| Q20.6 | Isomerism of atrial appendages |
| Q20.8 | Other congenital malformations of cardiac chambers and connections |
| Q20.9 | Congenital malformation of cardiac chambers and connections, unspecified |
| Q21.0 | Ventricular septal defect |
| Q21.1 | Atrial septal defect |
| Q21.2 | Atrioventricular septal defect |
| Q21.3 | Tetralogy of Fallot |
| Q21.4 | Aortopulmonary septal defect |
| Q21.8 | Other congenital malformations of cardiac septa |
| Q21.9 | Congenital malformation of cardiac septum, unspecified |
| Q22.0 | Pulmonary valve atresia |
| Q22.1 | Congenital pulmonary valve stenosis |
| Q22.2 | Congenital pulmonary valve insufficiency |
| Q22.3 | Other congenital malformations of pulmonary valve |
| Q22.4 | Congenital tricuspid stenosis |
| Q22.5 | Ebstein's anomaly |
| Q22.6 | Hypoplastic right heart syndrome |
| Q22.8 | Other congenital malformations of tricuspid valve |
| Q22.9 | Congenital malformation of tricuspid valve, unspecified |
| Q23.0 | Congenital stenosis of aortic valve |
| Q23.1 | Congenital insufficiency of aortic valve |
| Q23.2 | Congenital mitral stenosis |
| Q23.3 | Congenital mitral insufficiency |
| Q23.4 | Hypoplastic left heart syndrome |
| Q23.8 | Other congenital malformations of aortic and mitral valves |
| Q23.9 | Congenital malformation of aortic and mitral valves, unspecified |
| Q24.0 | Dextrocardia |
| Q24.1 | Levocardia |
| Q24.2 | Cor triatriatum |
| Q24.3 | Pulmonary infundibular stenosis |
| Q24.4 | Congenital subaortic stenosis |
| Q24.5 | Malformation of coronary vessels |
| Q24.6 | Congenital heart block |
| Q24.8 | Other specified congenital malformations of heart |
| Q24.9 | Congenital malformation of heart, unspecified |
| Q25.0 | Patent ductus arteriosus |
| Q25.1 | Coarctation of aorta |
| Q25.2 | |
| Q25.21 | Interruption of aortic arch |
| Q25.29 | Other atresia of aorta |
| Q25.3 | Supravalvular aortic stenosis |
| Q25.4 | |
| Q25.41 | Absence and aplasia of aorta |
| Q25.42 | Hypoplasia of aorta |
| Q25.43 | Congenital aneurysm of aorta |
| Q25.44 | Congenital dilation of aorta |
| Q25.45 | Double aortic arch |
| Q25.46 | Tortuous aortic arch |
| Q25.47 | Right aortic arch |
| Q25.48 | Anomalous origin of subclavian artery |
| Q25.49 | Other congenital malformations of aorta |
| Q25.5 | Atresia of pulmonary artery |
| Q25.6 | Stenosis of pulmonary artery |
| Q25.71 | Coarctation of pulmonary artery |
| Q25.72 | Congenital pulmonary arteriovenous malformation |
| Q25.79 | Other congenital malformations of pulmonary artery |
| Q25.8 | Other congenital malformations of other great arteries |
| Q25.9 | Congenital malformation of great arteries, unspecified |
| Q26.0 | Congenital stenosis of vena cava |
| Q26.1 | Persistent left superior vena cava |
| Q26.2 | Total anomalous pulmonary venous connection |
| Q26.3 | Partial anomalous pulmonary venous connection |
| Q26.4 | Anomalous pulmonary venous connection, unspecified |
| Q26.5 | Anomalous portal venous connection |
| Q26.6 | Portal vein-hepatic artery fistula |
| Q26.8 | Other congenital malformations of great veins |
| Q26.9 | Congenital malformation of great vein, unspecified |
| Q27.0 | Congenital absence and hypoplasia of umbilical artery |
| Q27.1 | Congenital renal artery stenosis |
| Q27.2 | Other congenital malformations of renal artery |
| Q27.31 | Arteriovenous malformation of vessel of upper limb |
| Q27.32 | Arteriovenous malformation of vessel of lower limb |
| Q27.33 | Arteriovenous malformation of digestive system vessel |
| Q27.34 | Arteriovenous malformation of renal vessel |
| Q27.39 | Arteriovenous malformation, other site |
| Q27.8 | Other specified congenital malformations of peripheral vascular system |
| Q27.9 | Congenital malformation of peripheral vascular system, unspecified |
| Q28.2 | Arteriovenous malformation of cerebral vessels |
| Q28.3 | Other malformations of cerebral vessels |
| I27.83 | Eisenmenger's syndrome |
Questions?
For more information, review the American College of Cardiology’s article announcing the new codes.