CPT code 33991: VAD insertion, left heart, arterial and venous access2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $415.46 for 33991 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 33991 nationwide

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

What 33991 covers

This service places a percutaneous ventricular assist device to support left-heart circulation, commonly for a patient with cardiogenic shock or during a high-risk cardiac intervention. A cardiologist, interventional cardiologist, or cardiac surgeon typically performs the procedure in a hospital catheterization laboratory or operating room. The distinguishing feature is use of both arterial and venous access; the related arterial-only insertion code is not interchangeable when the documented procedure requires both routes. The code includes radiological supervision and interpretation for device placement.

Report the code when the operative or catheterization report supports percutaneous left-heart device insertion and documents both access routes. The record should identify the indication, device, chamber supported, and access used. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur 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 may be available; co-surgeons and team surgery are not permitted. Modifier 50 is inappropriate.

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.

How Puerto Rico compares for 33991

Across 109 of 109 payment localities, the facility rate for 33991 runs from $365.74 in Wisconsin to $532.75 in Alaska. Puerto Rico pays $415.46. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

33991 rates by state

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

See 33991 in every payment locality

How the 33991 rate is calculated

Each of 33991’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.

Payment rules and modifiers for 33991

The CMS indicators that decide how 33991 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 33991

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

How 33991 has changed in Puerto Rico

Price 33991 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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

Open CMS sourceHow we calculate rates