CPT code 33405: Aortic valve replacement, standard prosthetic valve2026 Medicare rate & RVUs in Puerto Rico

Reports open surgical replacement of a diseased aortic valve using a conventional prosthesis, such as a mechanical or stented tissue valve.

CMS RVU26DEffective Oct 1, 2026One payment locality18.7K Medicare services in 2024

In Puerto Rico, Medicare pays $2,125.88 for 33405 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$2,125.88Hospital or facility

Check a contract rate as a % of Medicare · 33405 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 33405 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 33405 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 33405 covers

A cardiac surgeon removes the diseased aortic valve and implants a prosthesis during open surgery, typically using cardiopulmonary bypass. Common indications include severe aortic stenosis or regurgitation requiring surgical replacement. The implanted valve may be mechanical or a stented tissue prosthesis; this code distinguishes those options from a homograft or stentless tissue valve. These operations are performed in a hospital operating room, and CMS recorded 18,664 facility services for the code in 2024.

Report the code when the operative record supports open aortic valve replacement and identifies the implanted prosthesis sufficiently to distinguish it from the valve types represented by neighboring codes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

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.

How Puerto Rico compares for 33405

Across 109 of 109 payment localities, the facility rate for 33405 runs from $1,876.53 in Wisconsin to $2,678.21 in Alaska. Puerto Rico pays $2,125.88. The RVUs are the same everywhere; the geographic indexes change the dollars.

33405 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$2,125.88
  2. Los Angeles, CA · California$2,150.92+$25.04
  3. Washington, DC area · District of Columbia$2,315.85+$189.97
  4. Miami, FL · Florida$2,653.97+$528.09
  5. Chicago, IL · Illinois$2,569.30+$443.42
  6. Manhattan, NY · New York$2,479.83+$353.95
  7. Alaska · Alaska$2,678.21+$552.33

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

33405 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama—$1,925.43
ArkansasArkansas—$1,901.28
ArizonaArizona—$2,064.11
Bakersfield, CACalifornia—$2,064.10
Chico, CACalifornia—$2,037.08
El Centro, CACalifornia—$2,038.74
Fresno, CACalifornia—$2,037.08
Hanford, CACalifornia—$2,037.08

33405 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
33405 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

See 33405 in every payment locality

How the 33405 rate is calculated

Each of 33405’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 · 33405

RVUs × geographic indexes × conversion factor

Office or facility?

Work40.29

40.29 RVUs× 1.000 GPCI

Practice expense13.38

13.38 RVUs× 1.000 GPCI

Malpractice9.98

9.98 RVUs× 1.000 GPCI

Adjusted RVUs

63.6500

Conversion factor

$33.4009

Medicare rate

$2,125.97

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,936

Code
33405
Physician work
40.29
Practice expense
13.38
Malpractice
9.98

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Facility calculation for 33405 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work40.29× 1.00040.2900
Practice expense13.38× 1.01113.5272
Malpractice9.98× 0.9859.8303
Total RVUs63.6475
Conversion factor× 33.4009

Facility rate, Puerto Rico$2125.88

Facility: (40.29 × 1 + 13.38 × 1.011 + 9.98 × 0.985) × $33.4009 = $2125.88

Open 33405 in the RVU calculator

Payment rules and modifiers for 33405

33405 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33405

Aortic valve replacement, standard prosthetic valve

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 33405

Aortic valve replacement, standard prosthetic valve

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

33405 without 51 · national facility

$2,125.97

Aortic valve replacement, standard prosthetic valve

33405-51 · Second procedure: 50%

$1,062.99

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%).

When to use modifier 51

How 33405 has changed in Puerto Rico

33405 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$2,125.88RVU26D
2026-07-01Not available in this setting$2,125.88RVU26C
2026-04-01Not available in this setting$2,125.88RVU26B
2026-01-01Not available in this setting$2,125.88RVU26A
2025-10-01Not available in this setting$2,164.47RVU25D
2025-07-01Not available in this setting$2,164.47RVU25C
2025-04-01Not available in this setting$2,164.47RVU25B
2025-01-01Not available in this setting$2,164.47RVU25A
2024-10-01Not available in this setting$2,219.95RVU24D
2024-07-01Not available in this setting$2,219.95RVU24C
2024-04-01Not available in this setting$2,219.95RVU24B
2024-03-09Not available in this setting$2,219.95RVU24AR
2024-01-01Not available in this setting$2,183.71RVU24A
2023-10-01Not available in this setting$2,253.53RVU23D
2023-07-01Not available in this setting$2,254.52RVU23C
2023-04-01Not available in this setting$2,254.52RVU23B
2023-01-01Not available in this setting$2,254.52RVU23A
2022-10-01Not available in this setting$2,304.71RVU22D
2022-07-01Not available in this setting$2,304.71RVU22C
2022-04-01Not available in this setting$2,304.71RVU22B
2022-01-01Not available in this setting$2,304.71RVU22A
2021-10-01Not available in this setting$2,313.86RVU21D
2021-07-01Not available in this setting$2,313.86RVU21C
2021-04-01Not available in this setting$2,313.86RVU21B
2021-01-01Not available in this setting$2,313.86RVU21A
2020-10-01Not available in this setting$2,373.55RVU20D
2020-07-01Not available in this setting$2,373.55RVU20C
2020-04-01Not available in this setting$2,373.55RVU20B
2020-01-01Not available in this setting$2,373.55RVU20A
2019-10-01Not available in this setting$2,367.82RVU19D
2019-07-01Not available in this setting$2,367.82RVU19C
2019-04-01Not available in this setting$2,367.82RVU19B
2019-01-01Not available in this setting$2,367.82RVU19A
2018-10-01Not available in this setting$2,362.77RVU18D
2018-07-01Not available in this setting$2,362.77RVU18C
2018-04-01Not available in this setting$2,362.77RVU18B
2018-01-01Not available in this setting$2,362.77RVU18AR1
2017-10-01Not available in this setting$2,165.07RVU17D
2017-07-01Not available in this setting$2,165.07RVU17C
2017-04-01Not available in this setting$2,165.07RVU17B
2017-01-01Not available in this setting$2,165.07RVU17A
2016-10-01Not available in this setting$1,965.01RVU16D
2016-07-01Not available in this setting$1,965.01RVU16C
2016-04-01Not available in this setting$1,965.01RVU16B
2016-01-01Not available in this setting$1,965.01RVU16A
2015-10-01Not available in this setting$1,971.87RVU15D
2015-07-01Not available in this setting$1,971.87RVU15C
2015-04-01Not available in this setting$1,962.05RVU15B
2015-01-01Not available in this setting$1,962.05RVU15A
2014-10-01Not available in this setting$1,956.07RVU14D
2014-07-01Not available in this setting$1,956.07RVU14C
2014-04-01Not available in this setting$1,956.07RVU14B
2014-01-01Not available in this setting$1,956.07RVU14A
2013-10-01Not available in this setting$1,876.94RVU13D
2013-07-01Not available in this setting$1,876.94RVU13C
2013-04-01Not available in this setting$1,876.94RVU13B
2013-01-01Not available in this setting$1,876.94RVU13AR

Price 33405 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

33405 billing questions

When is 33405 selected instead of 33406 or 33410?

Use 33405 for a conventional prosthesis, such as a mechanical or stented tissue valve. The neighboring codes distinguish homograft and stentless tissue valve procedures.

What operative documentation supports 33405?

The operative report should establish open replacement of the aortic valve and identify the implanted valve type. This supports selecting the code rather than one for a homograft or stentless tissue valve.

How does the global period affect postoperative reporting?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How are other procedures from the same session paid?

The highest-valued procedure is paid in full; other procedures performed in the same session are subject to the standard multiple-procedure reduction.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.

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
RVUs for 33405PPRRVU2026_Oct_nonQPP.csv, line 3,936 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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