Aetna modified CPB 0407 for the Ross pulmonary autograft procedure and aortic valve-sparing re-implantation, effective September 26, 2025. Here's what billing teams need to know.
Aetna, a CVS Health company, updated its coverage policy under CPB 0407 Aetna system, covering CPT codes 33390, 33391, 33413, and 33440 for selected aortic valve procedures. The revised policy clarifies medical necessity criteria for the Ross procedure, minimally invasive aortic valve approaches, and valve-sparing re-implantation — and includes a critical exclusion for bicuspid valve patients with aortic regurgitation that can trigger claim denial if your ICD-10 coding isn't precise. If your facility performs these procedures on Aetna members, audit your charge capture now.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Selected Aortic Valve Procedures: Ross Pulmonary Autograft and Aortic Valve-Sparing Re-implantation |
| Policy Code | CPB 0407 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Cardiothoracic surgery, cardiac surgery, cardiovascular billing |
| Key Action | Verify ICD-10 specificity on all 33413 and 33440 claims before September 26, 2025 — bicuspid valve cases with aortic regurgitation (I35.1) are excluded |
Aetna Aortic Valve Procedure Coverage Criteria and Medical Necessity Requirements 2025
The Aetna Ross pulmonary autograft coverage policy under CPB 0407 covers four distinct interventions when specific medical necessity criteria are met. Know them before you bill.
The Ross Procedure (CPT 33413 and 33440)
Aetna considers the Ross pulmonary autograft procedure — CPT 33413 (replacement by translocation of autologous pulmonary valve with allograft replacement) and CPT 33440 (replacement by translocation of autologous pulmonary valve, transventricular aortic approach) — medically necessary for members undergoing aortic valve replacement due to congenital anomalies or aortic valve disease. Covered diagnoses include aortic incompetence (including endocarditis and rheumatic heart disease), aortic stenosis, and congenital lesions. Contraindications are listed in the policy appendix — review them before submitting prior authorization.
Minimally Invasive Approach (CPT 33390 and 33391)
Aetna accepts the minimally invasive approach to aortic valve replacement as an acceptable alternative to the conventional open approach. CPT 33390 and 33391 — both valvuloplasty of the aortic valve, open, with cardiopulmonary bypass — fall under this coverage policy when selection criteria are met. This is a billing-positive determination. It means you don't need to justify the minimally invasive approach against an open-surgery standard.
Aortic Valve-Sparing Re-implantation
Aetna covers aortic valve-sparing re-implantation for two specific indications. First, secondary aortic regurgitation caused by aortic root dilatation — as seen in Marfan syndrome. Second, type A acute aortic dissections, meaning dissection of the ascending and descending aorta. Both indications map to ICD-10 codes in the I71.x range. Get the specificity right — not just I71.0 (dissection, unspecified) when the record supports a more granular code.
Aortic Valve-Sparing Procedures for Aortic Root Ectasia and Ascending Aorta
Aetna also covers aortic valve-sparing procedures for aortic root ectasia and dissections and aneurysms of the ascending aorta. The relevant ICD-10 codes are in the I77.81x range (aortic ectasia) and I71.x range (aortic aneurysm and dissection). Map each claim to the most specific code available in the surgical record.
Prior Authorization
This policy doesn't explicitly state prior authorization requirements in the published summary. That said, these are high-cost surgical procedures. Check Aetna's prior authorization lists for your specific plan types before scheduling. Call Aetna provider services or check NaviNet to confirm PA requirements by plan — don't assume authorization isn't needed because the policy is silent.
The Bicuspid Valve Exclusion — Your Biggest Claim Denial Risk
The nonrheumatic aortic valve disorder codes I35.0 through I35.9 are listed with a critical caveat: Aetna does not cover these procedures for individuals with bicuspid valves and aortic regurgitation. This language is buried in the ICD-10 code group descriptions but it's a hard exclusion. If a patient has a bicuspid valve and aortic regurgitation and you bill CPT 33413 or 33440 with I35.1, expect a denial. Document clearly in the record whether the valve anatomy is bicuspid before submitting. Talk to your compliance officer if your cardiothoracic surgeons regularly operate on bicuspid valve patients — this exclusion has real reimbursement exposure.
Aetna Aortic Valve Procedure Exclusions and Non-Covered Indications
The published coverage policy under CPB 0407 doesn't list a broad "not covered" designation for these procedures. They're covered — but with important restrictions.
The clearest exclusion is the bicuspid valve with aortic regurgitation limitation on ICD-10 codes I35.0–I35.9 (nonrheumatic aortic valve disorders). Aetna explicitly notes these codes are not covered for patients with bicuspid valves and aortic regurgitation. This isn't a gray area. It's a documented exclusion that will produce a claim denial if you submit without checking the anatomy.
The policy also references contraindications to the Ross procedure in an appendix. Those contraindications aren't enumerated in the public summary, but they matter for prior authorization and medical necessity documentation. Pull the full CPB 0407 policy text and review the appendix before billing complex Ross cases.
Coverage Indications at a Glance
| Indication | Status | Relevant CPT Codes | Key ICD-10 Codes | Notes |
|---|---|---|---|---|
| Ross procedure — aortic valve replacement for congenital anomalies | Covered | 33413, 33440 | Q23.0, Q23.1, Q25.21–Q25.49, Q25.8, Q25.9 | Review contraindications appendix before PA request |
| Ross procedure — aortic incompetence (endocarditis, rheumatic) | Covered | 33413, 33440 | I06.1 | Rheumatic etiology supported |
| Ross procedure — aortic stenosis (rheumatic) | Covered | 33413, 33440 | I06.0 | Rheumatic etiology supported |
| Minimally invasive aortic valve replacement | Covered — acceptable alternative to open | 33390, 33391 | I06.0, I06.1, I35.x (non-bicuspid), Q23.x | No separate justification needed vs. open approach |
| Valve-sparing re-implantation — secondary aortic regurgitation / Marfan | Covered | 33390, 33391, 33413, 33440 | I71.x, I77.81x | Marfan with root dilatation is the primary example cited |
| Valve-sparing re-implantation — type A acute aortic dissection | Covered | 33390, 33391, 33413, 33440 | I71.0–I71.9 | Both ascending and descending dissection included |
| Aortic valve-sparing — aortic root ectasia | Covered | 33390, 33391, 33413, 33440 | I77.810–I77.819 | Aortic dilation codes |
| Aortic valve-sparing — ascending aorta dissection/aneurysm | Covered | 33390, 33391, 33413, 33440 | I71.1–I71.9 | Code to ascending vs. thoracic vs. abdominal specificity |
| Nonrheumatic aortic valve disorders in bicuspid valve with aortic regurgitation | Not Covered | 33413, 33440 | I35.0–I35.9 | Hard exclusion — document valve anatomy before billing |
Aetna Aortic Valve Procedure Billing Guidelines and Action Items 2025
1. Audit all CPT 33413 and 33440 claims in your queue before September 26, 2025.
Pull any pending or upcoming Aetna claims for these codes. Confirm the diagnosis coding matches the covered indications above. If a case involves a bicuspid valve, flag it for clinical documentation review before submission.
2. Update your charge capture for the bicuspid valve exclusion.
Add a charge capture checkpoint for I35.0–I35.9 claims paired with CPT 33413 or 33440. If the chart documents bicuspid aortic valve anatomy, route that claim for compliance review. A single missed exclusion here is a high-dollar denial.
3. Verify ICD-10 specificity for aortic dissection cases.
Don't default to I71.0 (dissection, unspecified) when the operative report supports a more specific code like I71.01 (dissection of thoracic aorta). Aetna's covered code list runs I71.0 through I71.9 — use the most accurate code the documentation supports.
4. Map Marfan syndrome cases correctly.
When valve-sparing re-implantation is performed for secondary aortic regurgitation due to Marfan syndrome, the underlying diagnosis drives the coverage determination. The Marfan diagnosis should appear in the claim record alongside the aortic root dilatation coding. Talk to your cardiothoracic coders about documentation requirements from the operative and clinical notes.
5. Confirm prior authorization status by plan before the effective date of September 26, 2025.
These aortic valve procedures are high-cost. Even if the policy doesn't mandate PA in the published text, individual Aetna plan types may require it. Check Aetna's PA lookup tool or NaviNet for each specific plan. Document your PA confirmation before the case.
6. Pull the full CPB 0407 text and review the contraindications appendix.
The published policy summary references a contraindications appendix for the Ross procedure. Those contraindications aren't in the summary — but they matter for medical necessity documentation. Your surgeons and billing team need to know what's in that appendix before requesting PA for complex Ross cases.
7. Train your cardiothoracic coders on this policy before the effective date.
The bicuspid valve exclusion, the distinction between valve-sparing and valve replacement approaches, and the Marfan/Type A dissection indications all require coder familiarity with the clinical nuances. Schedule a 30-minute training session with the CPB 0407 criteria in hand.
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Aortic Valve Procedures Under CPB 0407
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 33390 | CPT | Valvuloplasty, aortic valve, open, with cardiopulmonary bypass |
| 33391 | CPT | Valvuloplasty, aortic valve, open, with cardiopulmonary bypass |
| 33413 | CPT | Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement (Ross procedure) |
| 33440 | CPT | Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic approach |
Key ICD-10-CM Diagnosis Codes
All 65 codes listed in CPB 0407 are included below. Note the bicuspid valve exclusion on I35.x codes.
| Code | Description | Coverage Note |
|---|---|---|
| I06.0 | Rheumatic aortic stenosis | Covered |
| I06.1 | Rheumatic aortic insufficiency | Covered |
| I35.0 | Nonrheumatic aortic (valve) stenosis | Not covered for bicuspid valve with aortic regurgitation |
| I35.1 | Nonrheumatic aortic (valve) insufficiency | Not covered for bicuspid valve with aortic regurgitation |
| I35.2 | Nonrheumatic aortic (valve) stenosis with insufficiency | Not covered for bicuspid valve with aortic regurgitation |
| I35.3 | Nonrheumatic aortic (valve) disorder, unspecified | Not covered for bicuspid valve with aortic regurgitation |
| I35.4 | Nonrheumatic aortic valve disorder | Not covered for bicuspid valve with aortic regurgitation |
| I35.5 | Nonrheumatic aortic valve disorder | Not covered for bicuspid valve with aortic regurgitation |
| I35.6 | Nonrheumatic aortic valve disorder | Not covered for bicuspid valve with aortic regurgitation |
| I35.7 | Nonrheumatic aortic valve disorder | Not covered for bicuspid valve with aortic regurgitation |
| I35.8 | Nonrheumatic aortic valve disorder | Not covered for bicuspid valve with aortic regurgitation |
| I35.9 | Nonrheumatic aortic (valve) disorder, unspecified | Not covered for bicuspid valve with aortic regurgitation |
| I71.0 | Aortic aneurysm and dissection | Covered |
| I71.1 | Aortic aneurysm and dissection | Covered |
| I71.2 | Aortic aneurysm and dissection | Covered |
| I71.3 | Aortic aneurysm and dissection | Covered |
| I71.4 | Aortic aneurysm and dissection | Covered |
| I71.5 | Aortic aneurysm and dissection | Covered |
| I71.6 | Aortic aneurysm and dissection | Covered |
| I71.7 | Aortic aneurysm and dissection | Covered |
| I71.8 | Aortic aneurysm and dissection | Covered |
| I71.9 | Aortic aneurysm and dissection | Covered |
| I77.810 | Aortic ectasia (aortic dilation) | Covered |
| I77.811 | Aortic ectasia (aortic dilation) | Covered |
| I77.812 | Aortic ectasia (aortic dilation) | Covered |
| I77.813 | Aortic ectasia (aortic dilation) | Covered |
| I77.814 | Aortic ectasia (aortic dilation) | Covered |
| I77.815 | Aortic ectasia (aortic dilation) | Covered |
| I77.816 | Aortic ectasia (aortic dilation) | Covered |
| I77.817 | Aortic ectasia (aortic dilation) | Covered |
| I77.818 | Aortic ectasia (aortic dilation) | Covered |
| I77.819 | Aortic ectasia (aortic dilation) | Covered |
| Q23.0 | Congenital stenosis of aortic valve | Covered |
| Q23.1 | Congenital insufficiency of aortic valve | Covered |
| Q25.21 | Other congenital malformations of aorta | Covered |
| Q25.22 | Other congenital malformations of aorta | Covered |
| Q25.23 | Other congenital malformations of aorta | Covered |
| Q25.24 | Other congenital malformations of aorta | Covered |
| Q25.25 | Other congenital malformations of aorta | Covered |
| Q25.26 | Other congenital malformations of aorta | Covered |
| Q25.27 | Other congenital malformations of aorta | Covered |
| Q25.28 | Other congenital malformations of aorta | Covered |
| Q25.29 | Other congenital malformations of aorta | Covered |
| Q25.30 | Other congenital malformations of aorta | Covered |
| Q25.31 | Other congenital malformations of aorta | Covered |
| Q25.32 | Other congenital malformations of aorta | Covered |
| Q25.33 | Other congenital malformations of aorta | Covered |
| Q25.34 | Other congenital malformations of aorta | Covered |
| Q25.35 | Other congenital malformations of aorta | Covered |
| Q25.36 | Other congenital malformations of aorta | Covered |
| Q25.37 | Other congenital malformations of aorta | Covered |
| Q25.38 | Other congenital malformations of aorta | Covered |
| Q25.39 | Other congenital malformations of aorta | Covered |
| Q25.40 | Other congenital malformations of aorta | Covered |
| Q25.41 | Other congenital malformations of aorta | Covered |
| Q25.42 | Other congenital malformations of aorta | Covered |
| Q25.43 | Other congenital malformations of aorta | Covered |
| Q25.44 | Other congenital malformations of aorta | Covered |
| Q25.45 | Other congenital malformations of aorta | Covered |
| Q25.46 | Other congenital malformations of aorta | Covered |
| Q25.47 | Other congenital malformations of aorta | Covered |
| Q25.48 | Other congenital malformations of aorta | Covered |
| Q25.49 | Other congenital malformations of aorta | Covered |
| Q25.8 | Other congenital malformations of great arteries | Covered |
| Q25.9 | Congenital malformation of great arteries, unspecified | Covered |
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