CPT code 33366: TAVR, transapical approach2026 Medicare rate & RVUs in Guam
Reports aortic valve replacement using a catheter-delivered prosthesis introduced through the heart’s apex rather than a peripheral artery.
CMS doesn’t publish an office rate for 33366 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.
Your location
On this page 9 sections
What 33366 covers
This code represents transcatheter aortic valve replacement performed through a surgical opening at the heart’s apex. A cardiothoracic surgeon, often working with an interventional cardiologist as part of a heart team, introduces the prosthetic valve through the left ventricular apex and advances it across the native aortic valve. The procedure is typically performed in a hospital operating room or hybrid suite for a patient who needs aortic valve replacement and whose planned access route is transapical.
Select the code from the documented access route: transapical access distinguishes this service from peripheral arterial and transaortic approaches. The operative report should support valve implantation and identify the route; report a bypass-specific family code when cardiopulmonary bypass is used. This procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires medical-necessity documentation; 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.
33366 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $1,333.55 |
How the 33366 rate is calculated
Each of 33366’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 · 33366
RVUs × geographic indexes × conversion factor
Work28.62
28.62 RVUs× 1.000 GPCI
Practice expense6.45
6.45 RVUs× 1.000 GPCI
Malpractice6.86
6.86 RVUs× 1.000 GPCI
Adjusted RVUs
41.9300
Conversion factor
$33.4009
Medicare rate
$1,400.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33366
The CMS indicators that decide how 33366 is paid alongside other services.
CMS payment indicators · 33366
TAVR, 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
33366 without 51 · national facility
$1,400.50
TAVR, transapical approach
33366-51 · Second procedure: 50%
$700.25
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%).
33366 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33361TAVRPercutaneous femoral approach
- 33361 identifies a percutaneous approach; 33366 identifies transapical access through the heart’s apex.
- 33362Aortic valve replacementTranscatheter, open femoral access
- 33362 is for an open femoral artery approach, not transapical access.
- 33365Aortic valve replacementTransapical approach
- 33365 identifies a transaortic approach. Use 33366 when the valve is introduced through the heart’s apex.
- 33367TAVR bypass supportWith cardiopulmonary bypass
- 33367 is the transapical family code with a cardiopulmonary-bypass designation; 33366 is the transapical code without that designation.
33366 billing questions
When should 33366 be selected instead of another TAVR code?
Use 33366 when the prosthetic valve is delivered through transapical access at the heart’s apex. The documented route, rather than the diagnosis alone, distinguishes it from other TAVR approach codes.
How does 33366 differ from a bypass-specific TAVR code?
33366 identifies the transapical approach without the bypass-specific designation. If cardiopulmonary bypass is used, select the applicable bypass code for the documented approach.
Can modifier 50 be reported?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate for the procedure.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
When is assistant-at-surgery payment allowed?
Payment for an assistant at surgery requires documentation that the assistant was medically necessary. Co-surgeons are permitted, while team-surgery payment requires supporting documentation.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures performed in that session are paid at 50%.
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
Fee sheets
Put 33366 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet