CPT code 33364: TAVR, open iliac artery access2026 Medicare rate & RVUs in Missouri
Reports transcatheter aortic valve replacement when the prosthetic valve is delivered through surgically exposed iliac artery access.
CMS doesn’t publish an office rate for 33364 in Missouri.
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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What 33364 covers
This service replaces the aortic valve with a prosthetic valve delivered by catheter through an iliac artery that has been surgically exposed. A cardiac surgeon and interventional cardiologist may perform the procedure in a hospital hybrid operating room or catheterization laboratory, commonly for a patient with aortic stenosis when the iliac route is selected for valve delivery.
Select the code from the documented access route: 33364 identifies open iliac artery access. The operative report should establish the vessel exposed, the route used to deliver the valve, and valve deployment. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For qualifying procedures performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment requires medical-necessity documentation; co-surgeons are permitted, and team surgery 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 33364 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $1,247.03 |
| Metropolitan St. Louis, MO | Unavailable | $1,254.91 |
| Rest of Missouri | Unavailable | $1,229.75 |
How the 33364 rate is calculated
Each of 33364’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 · 33364
RVUs × geographic indexes × conversion factor
Work25.32
25.32 RVUs× 1.000 GPCI
Practice expense6.48
6.48 RVUs× 1.000 GPCI
Malpractice6.07
6.07 RVUs× 1.000 GPCI
Adjusted RVUs
37.8700
Conversion factor
$33.4009
Medicare rate
$1,264.89
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33364
The CMS indicators that decide how 33364 is paid alongside other services.
CMS payment indicators · 33364
TAVR, open iliac artery access
| 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
33364 without 51 · national facility
$1,264.89
TAVR, open iliac artery access
33364-51 · Second procedure: 50%
$632.45
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%).
33364 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33361TAVRPercutaneous femoral approach
- Use 33361 for percutaneous femoral artery access. Use 33364 when the iliac artery is surgically exposed for valve delivery.
- 33362Aortic valve replacementTranscatheter, open femoral access
- Both describe TAVR using open arterial access, but 33362 is for femoral access and 33364 is for iliac access.
- 33363TAVROpen axillary access
- 33363 identifies open axillary artery access; 33364 identifies open iliac artery access.
33364 billing questions
How is 33364 distinguished from other TAVR approach codes?
Choose 33364 when the valve is delivered through open iliac artery access. The operative report should identify the exposed vessel and delivery route.
Can modifier 50 be reported?
No. The aortic valve anatomy and procedure make a bilateral adjustment inappropriate.
What preoperative or postoperative care is included?
CMS assigns a 0-day global period, which includes same-day preoperative and postoperative care.
How does the multiple-procedure reduction work?
When qualifying procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
What documentation is needed for additional surgeons?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons are permitted; team surgery requires supporting documentation.
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
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