Does 33997 require prior authorization?

No, 33997 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 33997?

Medicare facility rate: $139.62. Non-facility rate: $139.62. Work RVU: 2.93.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

2.93

Facility

$139.62

Non-Facility

$139.62

Medical record documentation must support the specific diagnosis corresponding to one of the listed ICD-10-CM codes and explicitly state that IABP is not expected to be sufficient.
Clinical documentation should indicate the life-threatening nature (e.g., cardiogenic shock, multi-organ failure, or intra/postoperative circulatory collapse) and any supporting hemodynamic or organ-failure data.
Medical record must document diagnosis supporting one of the three life‑threatening situations and cite the relevant ICD‑10‑CM code(s).
Medical record must document that external counterpulsation (IABP) is not expected to be sufficient for the patient.

Percutaneous endovascular cardiac assist device is covered for cardiogenic shock (ICD-10-CM R57.0) when intraaortic balloon pump (IABP) is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for severe decompensated heart failure with threatening multi-organ failure when documented by one of the ICD-10-CM codes I50.21, I50.23, I50.41, I50.43, I97.110, I97.111, I97.130, or I97.131 and when IABP is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for intraoperative or postoperative circulatory system complications/disturbances documented by ICD-10-CM codes I97.790, I97.791, I97.88, or I97.89 when IABP is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for cardiogenic shock when external counterpulsation (IABP) is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for severe decompensated heart failure with threatening multi-organ failure when external counterpulsation (IABP) is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for intraoperative or postoperative complications/disturbances of the circulatory system when external counterpulsation (IABP) is not expected to be sufficient.

A53986 — Billing and Coding: Percutaneous Ventricular Assist Device

A53988 — Billing and Coding: Percutaneous Ventricular Assist Device

A59657 — Billing and Coding: Artificial Hearts and Percutaneous Endovascular Cardiac Assist Procedures and Devices

HUMANA-VENTRICULAR-ASSIST-DEVICE-TOTAL-ARTIFICIAL-HEART-MA — Ventricular Assist Device, Total Artificial Heart - Medicare Advantage

Ask Verity about documentation requirements, denial risks, or coverage in your state.