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AetnaAll Plans · Coverage · Medical Policy · Cardiology, Cardiothoracic SurgeryMedium impact

Selected Aortic Valve Procedures (CPB 0407, reviewed 2026-07-07)

Effective date
Not stated in the notice
Identified
Aug 16, 2026

Summary

Aetna considers the Ross pulmonary autograft procedure medically necessary for aortic valve replacement caused by congenital anomalies or aortic valve disease, and considers aortic valve-sparing re-implantation medically necessary for secondary aortic regurgitation from aortic root dilatation, such as in Marfan syndrome, and for type A acute aortic dissections. The Ross procedure and aortic valve-sparing re-implantation are considered experimental, investigational, or unproven for all other indications, and so are the Florida Sleeve valve-sparing procedure, Personalized External Aortic Root Support (PEARS), and the Matrix P bioprosthesis for pulmonary valve replacement in Ross procedures. the policy was last reviewed 07/07/2026.

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What to do

Action · 6 steps
01Billing team: Before scheduling or billing the Ross procedure (CPT 33413 or 33440) or the other codes in the policy table, confirm that the diagnosis is one the policy covers, such as aortic incompetence, aortic stenosis, congenital lesions, aortic valve disorders, or aortic aneurysm and dissection.
02Check that the patient does not have a contraindication listed in the policy: extremes of age, Marfan syndrome, multiple pathology in which a second valve replacement device is needed, multi-vessel coronary artery disease, or severely depressed left ventricular function.
03Do not schedule or bill the Ross procedure as covered for middle-aged or older adults when suitable alternatives with comparable results are available and the procedure would not need right ventricular outflow tract replacement.
04Do not bill bicuspid valves with aortic regurgitation or aortic dilation as covered when other alternatives are available.
05Aetna does not cover the Florida Sleeve or PEARS procedures, and neither has a specific code.
06Minimally invasive aortic valve approaches are an acceptable alternative to the conventional approach to aortic valve replacement.

Codes mentioned

33390333913341333440I06.0I06.1I35.0I35.9I71.00I71.9I77.810I77.819Q23.0Q23.1Q25.21Q25.49Q25.8Q25.9

Original notice

Selected Aortic Valve Procedures (CPB 0407, reviewed 2026-07-07)
aetna.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

Aetna policiesCardiologyCardiothoracic SurgeryCode 33390Code 33391Code 33413Code 33440Code I06.0Code I06.1Code I35.0Code I35.9Code I71.00Code I71.9Code I77.810Code I77.819Code Q23.0Code Q23.1Code Q25.21Code Q25.49Code Q25.8Code Q25.9

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