CPT code 33365: Aortic valve replacement, transapical approach2026 Medicare rate & RVUs in Guam
Reports transcatheter aortic valve replacement delivered through the heart’s apex when the documented access route is transapical.
CMS doesn’t publish an office rate for 33365 in Guam.
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 33365 covers
This service replaces the aortic valve with a catheter-delivered prosthesis introduced through the apex of the heart, typically using a surgical chest approach. A cardiac surgeon and interventional cardiology team may perform the procedure in a hospital hybrid operating room or catheterization suite. The transapical route is distinct from delivery through a peripheral artery and from conventional open valve replacement, in which the surgeon directly replaces the valve.
Report this code when the operative documentation supports transapical access and transcatheter valve deployment. Record the access route, valve procedure, and any additional procedures performed during the session. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity; co-surgeons are permitted, and team-surgery payment requires supporting documentation. Modifier 50 is inappropriate for this procedure.
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.
33365 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $1,213.12 |
How the 33365 rate is calculated
Each of 33365’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 · 33365
RVUs × geographic indexes × conversion factor
Work25.93
25.93 RVUs× 1.000 GPCI
Practice expense5.94
5.94 RVUs× 1.000 GPCI
Malpractice6.28
6.28 RVUs× 1.000 GPCI
Adjusted RVUs
38.1500
Conversion factor
$33.4009
Medicare rate
$1,274.24
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33365
The CMS indicators that decide how 33365 is paid alongside other services.
CMS payment indicators · 33365
Aortic valve replacement, transapical approach
| 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
33365 without 51 · national facility
$1,274.24
Aortic valve replacement, transapical approach
33365-51 · Second procedure: 50%
$637.12
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%).
33365 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33361TAVRPercutaneous femoral approach
- Use 33365 for transapical delivery through the heart’s apex; use 33361 when the catheter is introduced percutaneously through a femoral artery.
- 33362Aortic valve replacementTranscatheter, open femoral access
- 33362 identifies TAVR through an open femoral artery approach. The transapical route through the heart’s apex is reported with 33365.
- 33366TAVRTransapical approach
- 33366 is the sibling code for a different TAVR access route. Select between these codes based on the route documented in the operative report.
- 33405Aortic valve replacementStandard prosthetic valve
- 33365 describes catheter-based valve replacement using transapical access; 33405 is conventional surgical replacement of the aortic valve.
33365 billing questions
How does 33365 differ from 33361?
33365 identifies transapical delivery through the heart’s apex. 33361 is for transcatheter valve delivery through a percutaneous femoral artery approach.
Is this code for conventional open aortic valve replacement?
No. It describes catheter-based valve replacement using transapical access, not direct surgical replacement of the valve.
What documentation supports 33365?
The operative report should identify the transapical access route and document transcatheter prosthetic valve deployment. Document other procedures performed in the same session separately as applicable.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons are permitted; 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’s 0-day global period.
Can modifier 50 be used?
No. The aortic-valve procedure and its anatomy make a bilateral adjustment inappropriate.
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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