CPT code 33413: Aortic valve replacement, annular enlargement, transventricular approach2026 Medicare rate & RVUs in Missouri
Reports open aortic valve replacement that includes enlargement of the aortic annulus through a transventricular approach.
CMS doesn’t publish an office rate for 33413 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 33413 covers
This code describes open surgical replacement of the aortic valve combined with enlargement of the aortic annulus using a transventricular approach. A cardiothoracic surgeon may perform this operation when the annulus must be enlarged to accommodate the replacement valve. The procedure involves work beyond replacing the valve alone, including the annular enlargement and ventricular approach.
Report 33413 when the operative report supports both annular enlargement and the transventricular approach; valve replacement by itself does not establish this code. Documentation should identify the replacement, the enlargement, and the approach. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care for 90 days. 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. 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.
Where 33413 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 | $2,967.87 |
| Metropolitan St. Louis, MO | Unavailable | $2,987.34 |
| Rest of Missouri | Unavailable | $2,920.43 |
How the 33413 rate is calculated
Each of 33413’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 · 33413
RVUs × geographic indexes × conversion factor
Work58.37
58.37 RVUs× 1.000 GPCI
Practice expense17.90
17.90 RVUs× 1.000 GPCI
Malpractice14.00
14.00 RVUs× 1.000 GPCI
Adjusted RVUs
90.2700
Conversion factor
$33.4009
Medicare rate
$3,015.10
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33413
33413 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33413
Aortic valve replacement, annular enlargement, transventricular approach
| 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 · 33413
Aortic valve replacement, annular enlargement, transventricular approach
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
33413 without 51 · national facility
$3,015.10
Aortic valve replacement, annular enlargement, transventricular approach
33413-51 · Second procedure: 50%
$1,507.55
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%).
33413 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33405Aortic valve replacementStandard prosthetic valve
- 33405 describes aortic valve replacement without annular enlargement through a transventricular approach. Choose 33413 when the operative report supports both added features.
- 33411Aortic valve replacementTransventricular approach
- 33411 includes a transventricular approach but not annular enlargement. 33413 includes both.
- 33412Aortic valve replacementCoronary ostia translocation
- 33412 includes annular enlargement without a transventricular approach. 33413 includes the enlargement and the transventricular approach.
- 33414Aortic valve repairNative valve reconstruction
- 33414 is for repair of the aortic valve. Use 33413 when the valve is replaced and the annulus is enlarged through a transventricular approach.
33413 billing questions
When should 33413 be chosen over 33405?
Use 33413 when the aortic valve replacement includes annular enlargement through a transventricular approach. 33405 describes aortic valve replacement without those added features.
How does 33413 differ from 33412?
33413 includes annular enlargement and a transventricular approach. 33412 describes annular enlargement without the transventricular approach.
What operative documentation supports 33413?
The report should document aortic valve replacement, enlargement of the aortic annulus, and use of the transventricular approach.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that 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
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