CPT code 33981: VAD pump replacement, extracorporeal device2026 Medicare rate & RVUs in Missouri
Reports replacement of the pump in an extracorporeal ventricular assist device, whether the device supports one ventricle or both.
CMS doesn’t publish an office rate for 33981 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 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 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 | $748.40 |
| Metropolitan St. Louis, MO | Unavailable | $752.94 |
| Rest of Missouri | Unavailable | $739.72 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| 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) | 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
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%).
33981 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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