CPT code 33957: ECMO cannula repositioning, percutaneous, venovenous2026 Medicare rate & RVUs in Texas
Reports percutaneous repositioning of peripheral cannulae in a venovenous ECMO or ECLS circuit when the cannula position needs adjustment.
CMS doesn’t publish an office rate for 33957 in Texas.
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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On this page 9 sections
What 33957 covers
This service covers percutaneous adjustment of peripheral cannula position in a venovenous extracorporeal membrane oxygenation or extracorporeal life support circuit. It may be needed when a cannula is malpositioned or its position interferes with effective circuit flow. Cardiothoracic or vascular surgeons and other clinicians experienced in ECMO cannulation may perform the procedure in an operating room, catheterization laboratory, or intensive care setting. The service concerns repositioning an existing peripheral cannula, not placing or removing one.
Select the code when the documented procedure is percutaneous repositioning for venovenous support; the record should identify the cannula site, the reason for adjustment, and the technique performed. CMS assigns 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 other procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are 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 33957 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $168.76 |
| Beaumont, TX | Unavailable | $165.51 |
| Brazoria, TX | Unavailable | $164.64 |
| Dallas, TX | Unavailable | $167.04 |
| Fort Worth, TX | Unavailable | $167.11 |
| Galveston, TX | Unavailable | $166.01 |
| Houston, TX | Unavailable | $181.02 |
| Rest of Texas | Unavailable | $165.91 |
How the 33957 rate is calculated
Each of 33957’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 · 33957
RVUs × geographic indexes × conversion factor
Work3.42
3.42 RVUs× 1.000 GPCI
Practice expense0.85
0.85 RVUs× 1.000 GPCI
Malpractice0.82
0.82 RVUs× 1.000 GPCI
Adjusted RVUs
5.0900
Conversion factor
$33.4009
Medicare rate
$170.01
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33957
The CMS indicators that decide how 33957 is paid alongside other services.
CMS payment indicators · 33957
ECMO cannula repositioning, percutaneous, venovenous
| 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) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33957 without 51 · national facility
$170.01
ECMO cannula repositioning, percutaneous, venovenous
33957-51 · Second procedure: 50%
$85.01
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%).
33957 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33958Cannula repositioningOpen, younger than six years
- Both codes cover percutaneous repositioning of peripheral ECMO/ECLS cannulae; 33957 is selected for venovenous support, while 33958 represents a different circuit configuration.
- 33951ECMO cannulationPercutaneous, age 5 or older
- 33951 is for peripheral cannula insertion. Use 33957 when the service adjusts the position of an existing cannula percutaneously.
- 33965ECMO cannula removalPercutaneous, age five and older
- 33965 describes removal of a peripheral ECMO/ECLS cannula, not adjustment of its position.
- 33948ECMO managementVenovenous support
- 33948 is for daily management of venovenous ECMO/ECLS; 33957 is for a percutaneous cannula repositioning procedure.
33957 billing questions
How is this code distinguished from 33958?
Both codes describe percutaneous repositioning of peripheral ECMO/ECLS cannulae. Choose based on the circuit configuration documented; 33957 is for venovenous support.
Can this be reported for initial cannula placement?
No. This code describes repositioning an existing peripheral cannula. Use the applicable insertion code when the service places a cannula.
Is same-day postoperative care separately reported?
Same-day preoperative and postoperative care is included in this procedure's 0-day global period.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
When is assistant-at-surgery payment allowed?
Only when the record documents medical necessity for the assistant. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple procedure reduction.
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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