Transcarotid TAVR: Unlisted Code 33799

Question:

My hospital wants to pursue elective TAVR via carotid approach. Normally via percutaneous femoral approach, the Interventional Cardiologist and Cardiac Surgeon bill for the case. If they request me for open carotid artery exposure (as Vascular Surgeon), is there a way for me to bill as a third provider?

Answer:

There is currently no specific CPT code for transcarotid TAVR, so the entire procedure is reported using unlisted cardiac surgery code 33799. When submitting 33799, it is best practice to include a crosswalk to the comparable TAVR code range 33361–33366 to support valuation and reimbursement. Because all TAVR/TAVI codes include vascular access, exposure, and closure as bundled components, separately billing for access (e.g., carotid cutdown or repair) would not be appropriate. TAVR procedures are intended to be performed by two co-surgeons—a cardiothoracic surgeon and an interventional cardiologist, who each report the procedure using modifier 62 (co-surgery). If a vascular surgeon participates in the case for carotid exposure, the only potential billing pathway would be to attempt team-surgery reporting (modifier 66). However, this is not always accepted and would require that the payer recognizes the team-surgery model and that documentation supports the medical necessity of both the carotid approach and the involvement of all participating surgeons. Because the carotid approach remains an unlisted service, obtaining payer preauthorization or a pre-determination of coverage is strongly recommended to confirm acceptance of both the unlisted code (33799) and the team-surgery structure before scheduling an elective case.

*This response is based on the best information available as of 04/02/26.