Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-06-05)

By 2026-06-05: Billing team must immediately update claim submission rules in billing software. (1) CPT codes 0345T, 33418, and 33419 are COVERED ONLY if patient meets strict criteria: chronic symptomatic mitral regurgitation despite maximal medical therapy AND not a surgical candidate. Add prior authorization requirement and coverage validation before claim submission. (2) CPT codes 0483T and 0484T are COVERED ONLY for mitral valve-in-valve replacement when heart team (including cardiac surgeon) documents STS score ≥8% predicted surgical mortality risk. (3) CPT codes 0545T, 0569T, 0570T, 0646T, 0805T, 0806T, and 33340 are NON-COVERED—these codes must be flagged as INVESTIGATIONAL/EXPERIMENTAL and claims will be DENIED. Update denial templates to cite investigational status. (4) CPT 82777 and 83006 (biomarkers) are NON-COVERED and should be removed from covered code lists. (5) Update ICD-10 code validation: I34.0-I34.9 are covered for degenerative mitral regurgitation only (NOT for concomitant moderate-to-severe MR with cardiogenic shock or refractory pulmonary edema). ICD-10 codes I01.1, I33.0-I33.9, I36.1, I38, J81.0-J81.1, and R57.0 trigger automatic denials for these procedures. (6) Providers must document in operative notes: (a) medical therapy history, (b) reason patient is not surgical candidate (if applicable), or (c) STS score and heart team assessment (for ViV cases). Add documentation checklist to EMR templates for cardiothoracic and interventional cardiology. (7) All claims for tricuspid valve repair (CPT 0569T, 0570T, 0646T) will be denied—educate cardiology and cardiac surgery staff immediately. Failure to implement will result in claim denials and potential overpayment recoupment from the practice.