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CPT code 33981: VAD pump replacement, extracorporeal device2026 Medicare rate & RVUs

Reports replacement of the pump in an extracorporeal ventricular assist device, whether the device supports one ventricle or both.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $757.87 for 33981 nationally in a facility.

Medicare rate · 33981

VAD pump replacement, extracorporeal device

Office or facility?

Work RVUs
15.71
Total RVUs
22.69
Global days
XXX

National rate · 2026

$757.87

Facility setting, before claim adjustments.

See every locality for 33981 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 33981 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 33981 covers

This service replaces the external pump component of an extracorporeal ventricular assist device (VAD) used to support circulation when a patient’s heart cannot provide adequate output. It is generally performed by a cardiac surgeon in an operating room or comparable surgical setting. The code distinguishes an extracorporeal pump exchange from replacement of an implanted intracorporeal VAD pump.

Report the code when the operative record supports replacement of the extracorporeal VAD pump, not initial device placement or device removal alone. Documentation should identify the VAD as extracorporeal, describe the pump replacement, and establish whether the device supports one or both ventricles. When multiple procedures are performed in the same session, CMS applies the standard multiple procedure reduction: the highest-valued procedure is paid in full, and other procedures are paid at 50%.

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 33981 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

33981 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$690.02
AlaskaUnavailable$971.00
ArizonaUnavailable$736.49
ArkansasUnavailable$681.91
Atlanta, GAUnavailable$786.34
Austin, TXUnavailable$750.89
Bakersfield, CAUnavailable$729.22
Baltimore area, MDUnavailable$803.82
Beaumont, TXUnavailable$739.26
Brazoria, TXUnavailable$733.54

33981 rates by state

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

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Explore a state

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
33981 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

How the 33981 rate is calculated

Each of 33981’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 · 33981

RVUs × geographic indexes × conversion factor

Office or facility?

Work15.71

15.71 RVUs× 1.000 GPCI

Practice expense3.23

3.23 RVUs× 1.000 GPCI

Malpractice3.75

3.75 RVUs× 1.000 GPCI

Adjusted RVUs

22.6900

Conversion factor

$33.4009

Medicare rate

$757.87

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

Payment rules and modifiers for 33981

The CMS indicators that decide how 33981 is paid alongside other services.

CMS payment indicators · 33981

VAD pump replacement, extracorporeal device

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
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)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

33981 without 51 · national facility

$757.87

VAD pump replacement, extracorporeal device

33981-51 · Second procedure: 50%

$378.94

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

33981 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 33981

    VAD pump replacement, extracorporeal device15.71 wRVU

    Not priced

  • 33982

    VAD pump replacement, intracorporeal, without bypass36.91 wRVU

    Not priced

  • 33983

    VAD pump replacement, intracorporeal, with bypass43.43 wRVU

    Not priced

  • 33975

    Ventricular assist device, extracorporeal, biventricular24.38 wRVU

    Not priced

  • 33977

    VAD removal, extracorporeal, single ventricle20.34 wRVU

    Not priced

How to choose

33982VAD pump replacementIntracorporeal, without bypass
Use 33982 for replacement of an intracorporeal VAD pump without bypass. Code 33981 is for an extracorporeal VAD pump.
33983VAD pump replacementIntracorporeal, with bypass
Use 33983 for replacement of an intracorporeal VAD pump with bypass. Code 33981 describes an extracorporeal pump replacement.
33975Ventricular assist deviceExtracorporeal, biventricular
Code 33975 reports initial placement of an extracorporeal VAD; 33981 reports replacement of its pump.
33977VAD removalExtracorporeal, single ventricle
Code 33977 is for removal of an extracorporeal VAD. It does not describe replacement of the pump.

Codes related to 33981

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 33981
CodeHow it relatesNational office range
Same family
33982VAD pump replacement, intracorporeal, without bypassReplacement code for an intracorporeal VAD pump without bypass.No office rate
33983VAD pump replacement, intracorporeal, with bypassReplacement code for an intracorporeal VAD pump with bypass.No office rate
33977VAD removal, extracorporeal, single ventricleRemoval procedure for an extracorporeal VAD, rather than pump replacement.No office rate

33981 billing questions

How does this differ from 33982 or 33983?

Code 33981 is for replacement of an extracorporeal VAD pump. Codes 33982 and 33983 concern replacement of an intracorporeal VAD pump; the distinction between those codes is whether bypass is used.

Is this code for initial VAD placement?

No. It describes replacement of the pump in an existing extracorporeal VAD, rather than initial placement of an extracorporeal VAD.

Can this be reported for VAD removal alone?

No. Removal alone is a different service; the operative documentation must support pump replacement.

How are multiple procedures paid in the same session?

CMS pays the highest-valued procedure in full and other procedures at 50% when multiple procedures are performed in the same session.

What should the operative report establish?

It should identify the device as extracorporeal and document that its pump was replaced. It should also clarify whether the VAD supports one ventricle or both.

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 33981PPRRVU2026_Oct_nonQPP.csv, line 4,165 (RVU26D)

Open CMS sourceHow we calculate rates

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