CPT code 33840: Coarctation repair, direct anastomosis2026 Medicare rate & RVUs in Missouri
Reports surgical removal of a narrowed aortic segment followed by direct reconnection of the aortic ends to repair coarctation.
CMS doesn’t publish an office rate for 33840 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 33840 covers
The surgeon removes the narrowed segment of the aorta and reconnects the remaining ends directly, creating an end-to-end anastomosis. This operation treats aortic coarctation, usually a congenital narrowing, and is typically performed by a congenital cardiac or cardiothoracic surgeon in a hospital operating room. Patients are often infants or children, though coarctation may be repaired later in life.
Choose this code when the operative report supports excision of the coarctation and direct anastomosis, rather than reconstruction with an interposition graft or patch. 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 others are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation. Team surgery is not permitted, and modifier 50 is inappropriate for this anatomy.
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 33840 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 | $1,162.13 |
| Metropolitan St. Louis, MO | Unavailable | $1,170.60 |
| Rest of Missouri | Unavailable | $1,137.30 |
How the 33840 rate is calculated
Each of 33840’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 · 33840
RVUs × geographic indexes × conversion factor
Work20.81
20.81 RVUs× 1.000 GPCI
Practice expense9.45
9.45 RVUs× 1.000 GPCI
Malpractice5.23
5.23 RVUs× 1.000 GPCI
Adjusted RVUs
35.4900
Conversion factor
$33.4009
Medicare rate
$1,185.40
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33840
33840 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33840
Coarctation repair, direct anastomosis
| 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 · 33840
Coarctation repair, direct anastomosis
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
33840 without 51 · national facility
$1,185.40
Coarctation repair, direct anastomosis
33840-51 · Second procedure: 50%
$592.70
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%).
33840 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33845Coarctation repairGraft reconstruction
- Both address aortic coarctation excision, but 33845 is for reconstruction with a graft; 33840 requires direct reconnection of the aortic ends.
- 33851Coarctation repairSubclavian flap or prosthetic patch
- Choose 33851 for the specified left subclavian artery or prosthetic patch repair, rather than the direct end-to-end anastomosis reported with 33840.
- 33852Aortic arch repairWithout bypass
- Code 33852 describes repair of a hypoplastic aortic arch without bypass. Code 33840 describes excision of a coarctation with direct anastomosis.
- 33853Aortic arch repairWith bypass
- Code 33853 describes repair of a hypoplastic aortic arch with bypass; 33840 is for coarctation excision and direct anastomosis.
33840 billing questions
How is this code distinguished from 33845?
Use 33840 when the surgeon reconnects the aortic ends directly after removing the narrowed segment. Code 33845 describes excision with graft reconstruction.
What operative documentation supports 33840?
The operative report should identify the coarctation, its excision, and direct anastomosis of the remaining aortic ends. Documentation of an interposition graft or patch points to a different repair method.
Can modifier 50 be appended?
No. The anatomy and descriptor make a bilateral adjustment inappropriate for this repair.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation.
What postoperative care is included?
The 90-day global period 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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