CPT code 33340: Appendage closure, transcatheter implant2026 Medicare rate & RVUs in California
Reports catheter-based placement of an implant to close the left atrial appendage, commonly for stroke-risk reduction in patients with atrial fibrillation.
CMS doesn’t publish an office rate for 33340 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 33340 covers
An interventional cardiologist or electrophysiologist advances a catheter through a transseptal route and places an endocardial implant to close the left atrial appendage. The procedure is generally performed in a hospital catheterization or electrophysiology lab with imaging guidance. It is used for selected patients with atrial fibrillation when a strategy to reduce embolic stroke risk is being pursued; the record should identify the indication, implant placement, and procedural findings.
Report 33340 for the transcatheter closure procedure, including its transseptal access and integral fluoroscopic and angiographic guidance. The code has a 0-day global period, so same-day preoperative and postoperative care is included. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment requires documented medical necessity; co-surgeons are permitted, and team-surgery payment requires supporting documentation.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 33340 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $614.05 |
| Chico, CA | Unavailable | $607.65 |
| El Centro, CA | Unavailable | $608.05 |
| Fresno, CA | Unavailable | $607.65 |
| Hanford, CA | Unavailable | $607.65 |
| Los Angeles, CA | Unavailable | $643.67 |
| Madera, CA | Unavailable | $607.65 |
| Marin County, CA | Unavailable | $692.45 |
| Merced, CA | Unavailable | $607.65 |
| Modesto, CA | Unavailable | $607.65 |
| Napa, CA | Unavailable | $666.63 |
| Oxnard, CA | Unavailable | $635.90 |
| Redding, CA | Unavailable | $607.65 |
| Rest of California | Unavailable | $607.65 |
| Riverside, CA | Unavailable | $632.87 |
| Sacramento, CA | Unavailable | $627.82 |
| Salinas, CA | Unavailable | $625.33 |
| San Benito County, CA | Unavailable | $710.11 |
| San Diego, CA | Unavailable | $633.10 |
| San Francisco, CA | Unavailable | $689.78 |
| San Luis Obispo, CA | Unavailable | $616.53 |
| Santa Clara County, CA | Unavailable | $699.19 |
| Santa Cruz, CA | Unavailable | $633.55 |
| Santa Maria, CA | Unavailable | $625.77 |
| Santa Rosa, CA | Unavailable | $639.24 |
| Stockton, CA | Unavailable | $607.65 |
| Vallejo, CA | Unavailable | $662.78 |
| Visalia, CA | Unavailable | $607.65 |
| Yuba City, CA | Unavailable | $607.65 |
How the 33340 rate is calculated
Each of 33340’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 33340
RVUs × geographic indexes × conversion factor
Work9.99
9.99 RVUs× 1.000 GPCI
Practice expense6.18
6.18 RVUs× 1.000 GPCI
Malpractice2.35
2.35 RVUs× 1.000 GPCI
Adjusted RVUs
18.5200
Conversion factor
$33.4009
Medicare rate
$618.58
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33340
The CMS indicators that decide how 33340 is paid alongside other services.
CMS payment indicators · 33340
Appendage closure, transcatheter implant
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 2 | Permitted. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33340 without 51 · national facility
$618.58
Appendage closure, transcatheter implant
33340-51 · Second procedure: 50%
$309.29
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
33340 compared with similar codes
Compare codes · National
33340 vs 93656 vs 33361: Medicare rates
How to choose
- 93656AF ablationPulmonary vein isolation
- 93656 reports catheter ablation directed at atrial fibrillation. Use 33340 for placement of an implant to close the left atrial appendage; both services may be performed in one session.
- 33361TAVRPercutaneous femoral approach
- 33361 reports transcatheter replacement of the aortic valve. It treats a different cardiac structure and is not the code for left atrial appendage closure.
33340 billing questions
When should 33340 be reported instead of an atrial fibrillation ablation code?
Report 33340 for catheter-based implant closure of the left atrial appendage. Atrial fibrillation ablation treats the arrhythmia itself; appendage closure is intended to reduce embolic stroke risk.
Does 33340 include transseptal access and fluoroscopic guidance?
Yes. The closure service includes the transseptal catheter access and integral fluoroscopic and angiographic guidance used for implant placement.
Can an assistant surgeon be billed for this procedure?
Assistant-at-surgery payment is allowed only when the record supports medical necessity. Co-surgeons are permitted, while team-surgery payment requires supporting documentation.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure. The code has no postoperative global days beyond the date of service.
How is 33340 paid when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and the other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this procedure.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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