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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Cardiology, Cardiothoracic SurgeryMedium impact

Transcatheter Pulmonary Valve Implantation

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Transcatheter pulmonary valve implantation with an FDA-approved valve is considered medically necessary for individuals with congenital heart disease and current right ventricular outflow tract (RVOT) obstruction or regurgitation, including right ventricle-to-pulmonary artery conduit or native or patched RVOT with at least moderate pulmonic regurgitation, or pulmonic stenosis with a mean RVOT gradient of at least 35 mm Hg. It is considered investigational for all other indications. The 10/19/2026 policy history entry records a description update regarding devices, with the policy statements unchanged, and a code reference update that removed ICD-9 procedure and diagnosis codes.

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What to do

Action · 3 steps
01Billing team: Transcatheter pulmonary valve implantation is medically necessary only for the listed indications and only when performed according to the policy section, and it is investigational for all other indications.
02The covered codes are CPT 33477, ICD-10 procedure codes 02RH3JZ and 02RH4JZ, and ICD-10 diagnosis codes I97.110, I97.111, I97.120, I97.121, I97.130, I97.131, I97.190, I97.191, Q20.5, Q21.3, Q22.0, Q22.1, Q22.2 and Q22.3.
03The policy states that no payment is made for services not documented to be medically necessary, and that a provider prescribing or recommending a service does not in itself make it medically necessary.

Codes mentioned

33477I97.110I97.111I97.120I97.121I97.130I97.131I97.190I97.191Q20.5Q21.3Q22.0Q22.1Q22.2Q22.3

Original notice

Transcatheter Pulmonary Valve Implantation
bcbsms.com · Always check the source before changing claims.
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Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesCardiologyCardiothoracic SurgeryCode 33477Code I97.110Code I97.111Code I97.120Code I97.121Code I97.130Code I97.131Code I97.190Code I97.191Code Q20.5Code Q21.3Code Q22.0Code Q22.1Code Q22.2Code Q22.3

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