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BETA v.3.0

2025 CPT code 0646T

Transcatheter tricuspid valve implantation/replacement with prosthetic valve, percutaneous approach.

Medical necessity must be established for TTVI procedures. Generally, it is considered medically necessary for patients with severe tricuspid valve disease who are at high risk for conventional open-heart surgery or have failed previous surgical interventions.

IMPORTANT:(Do not report 0646T in conjunction with 33210, 33211 for temporary pacemaker insertion) (Do not report 0646T in conjunction with 93451, 93453, 93456, 93457, 93460, 93461, 93503, 93566, 93593, 93594, 93596, 93597, for diagnostic right heart catheterization procedures intrinsic to the valve repair procedure) (Do not report 0646T in conjunction with 93662 for imaging guidance with intracardiac echocardiography) (For transcatheter tricuspid valve annulus reconstruction, use 0545T) (For transcatheter tricuspid valve repair, see 0569T, 0570T)

In simple words: The provider implants a prosthetic tricuspid valve, or replaces one, using a catheter inserted through a small incision in the skin and threaded through a vessel to the heart. This procedure may help reduce tricuspid regurgitation, where the valve doesn't close properly.

Transcatheter tricuspid valve implantation (TTVI)/replacement with prosthetic valve, percutaneous approach, including right heart catheterization, temporary pacemaker insertion, and selective right ventricular or right atrial angiography, when performed.

Example 1: A patient with severe tricuspid regurgitation not amenable to open surgery undergoes TTVI with a prosthetic valve via a percutaneous approach. Right heart catheterization, temporary pacemaker insertion, and selective right ventricular angiography are performed during the procedure., A patient with a failing bioprosthetic tricuspid valve undergoes transcatheter tricuspid valve replacement with a new prosthetic valve. The procedure is performed percutaneously and includes right heart catheterization and right atrial angiography. A temporary pacemaker is inserted for rapid pacing during valve deployment., A patient with congenital tricuspid valve stenosis undergoes transcatheter tricuspid valve implantation with a prosthetic valve. The procedure involves a percutaneous approach and includes temporary pacemaker placement and selective right ventricular and right atrial angiography for guidance.

Documentation should include the pre- and post-procedural echocardiogram reports, procedural details, including the type of prosthetic valve used, approach used (percutaneous), use of temporary pacemaker, angiography details (if performed), and any complications encountered.

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