CPT code 33991: VAD insertion, left heart, arterial and venous access2026 Medicare rate & RVUs in Texas
Reports percutaneous placement of a left-heart ventricular assist device when both arterial and venous access are used for temporary circulatory support.
CMS doesn’t publish an office rate for 33991 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 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.
Where 33991 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 | $412.00 |
| Beaumont, TX | Unavailable | $405.64 |
| Brazoria, TX | Unavailable | $402.48 |
| Dallas, TX | Unavailable | $408.43 |
| Fort Worth, TX | Unavailable | $408.73 |
| Galveston, TX | Unavailable | $405.90 |
| Houston, TX | Unavailable | $443.60 |
| Rest of Texas | Unavailable | $406.15 |
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.
How the rate is built · 33991
RVUs × geographic indexes × conversion factor
Work8.62
8.62 RVUs× 1.000 GPCI
Practice expense1.77
1.77 RVUs× 1.000 GPCI
Malpractice2.06
2.06 RVUs× 1.000 GPCI
Adjusted RVUs
12.4500
Conversion factor
$33.4009
Medicare rate
$415.84
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33991
The CMS indicators that decide how 33991 is paid alongside other services.
CMS payment indicators · 33991
VAD insertion, left heart, arterial and venous access
| 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) | 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
33991 without 51 · national facility
$415.84
VAD insertion, left heart, arterial and venous access
33991-51 · Second procedure: 50%
$207.92
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%).
33991 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33990VAD insertionLeft heart, arterial access
- Both codes cover percutaneous left-heart VAD insertion. Choose 33991 when arterial and venous access are used; choose 33990 for arterial access only.
- 33992VAD removalPercutaneous left-heart device
- 33991 reports insertion of a percutaneous left-heart VAD; 33992 reports removal of that device.
- 33995VAD insertionPercutaneous, right heart
- 33991 is for percutaneous left-heart VAD insertion with arterial and venous access. 33995 describes percutaneous right-heart VAD insertion through venous access.
33991 billing questions
When should 33991 be chosen instead of 33990?
Use 33991 when the percutaneous left-heart VAD insertion uses both arterial and venous access. Use 33990 when the insertion uses arterial access only.
Is imaging guidance separately reported with this code?
Radiological supervision and interpretation for device placement are included in the insertion service.
Can modifier 50 be reported?
No. Bilateral adjustment does not apply, and modifier 50 is inappropriate for this descriptor and anatomy.
How does the multiple-procedure rule affect payment?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction.
Can an assistant surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeons and team surgery are not permitted for this code.
What documentation distinguishes this from a later removal?
Document that a left-heart percutaneous VAD was inserted and that both arterial and venous access were used. Removal is a separate service, reported with the applicable removal code.
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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