CPT code 33406: Aortic valve replacement, homograft or stentless valve2026 Medicare rate & RVUs in Guam
Open replacement of a diseased aortic valve using a homograft or stentless valve, reported when the operative record supports that implant type.
CMS doesn’t publish an office rate for 33406 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 33406 covers
Code 33406 represents open aortic valve replacement performed with cardiopulmonary bypass using a homograft or stentless valve. A cardiac surgeon removes the diseased native valve and implants the selected replacement during major heart surgery, typically in a hospital operating room. The implanted valve type—not simply the diagnosis or the fact that the valve is biologic—distinguishes this service from other aortic valve replacement coding.
Report the code when the operative record supports open replacement, cardiopulmonary bypass, and use of a homograft or stentless valve. The procedure has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. CMS may pay an assistant at surgery; co-surgeon payment requires supporting documentation, and team surgery payment is not permitted. Modifier 50 is inappropriate for this code.
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.
33406 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $2,569.75 |
How the 33406 rate is calculated
Each of 33406’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 · 33406
RVUs × geographic indexes × conversion factor
Work51.36
51.36 RVUs× 1.000 GPCI
Practice expense15.89
15.89 RVUs× 1.000 GPCI
Malpractice12.97
12.97 RVUs× 1.000 GPCI
Adjusted RVUs
80.2200
Conversion factor
$33.4009
Medicare rate
$2,679.42
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33406
33406 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33406
Aortic valve replacement, homograft or stentless valve
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 33406
Aortic valve replacement, homograft or stentless 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33406 without 51 · national facility
$2,679.42
Aortic valve replacement, homograft or stentless valve
33406-51 · Second procedure: 50%
$1,339.71
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%).
33406 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33405Aortic valve replacementStandard prosthetic valve
- Choose 33406 for a homograft or stentless valve. Choose 33405 for a prosthetic valve that is neither of those types.
- 33440Aortic valve replacementRoss procedure
- 33440 describes the Ross procedure, which uses the patient's pulmonary valve in the aortic position and replaces the pulmonary valve. It is not a single-valve homograft or stentless replacement.
- 33414Aortic valve repairNative valve reconstruction
- 33414 is an aortic valve repair code. Use 33406 when the operation replaces the valve with a homograft or stentless valve.
33406 billing questions
How is 33406 different from 33405?
33406 applies when the operative record identifies a homograft or stentless valve. Code 33405 is for a prosthetic valve other than those types.
Is cardiopulmonary bypass included?
Yes. The code describes open aortic valve replacement performed with cardiopulmonary bypass.
Can another procedure be reported during the same operation?
A separately reportable procedure may be subject to the standard multiple procedure reduction when performed in the same session. The operative documentation must support each reported service.
Which modifiers or surgical assistance rules should the biller consider?
Modifier 50 is inappropriate. CMS may pay an assistant at surgery, while co-surgeon payment requires supporting documentation; team surgery payment is not permitted.
What care is included in the global period?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
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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