CPT code 33992: VAD removal, percutaneous left-heart device2026 Medicare rate & RVUs in Montana
Removal of a percutaneously placed left-heart ventricular assist device is reported when temporary mechanical circulatory support is discontinued.
In Montana, Medicare pays $164.95 for 33992 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 33992 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 33992 covers
This service covers withdrawing a catheter-based ventricular assist device used to support the left heart. It is commonly performed by an interventional cardiologist or cardiac surgeon in a catheterization laboratory or other procedural setting when the patient’s hemodynamic condition allows temporary support to end. The code identifies removal of the percutaneous left-heart device, rather than implantation, repositioning, or removal of a right-heart device.
Report the code when the documented service removes that percutaneous left-heart VAD; the record should identify the device and support the removal performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this descriptor. Assistant-at-surgery services may be paid; 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.
How Montana compares for 33992
Across 109 of 109 payment localities, the facility rate for 33992 runs from $145.12 in Wisconsin to $211.92 in Alaska. Montana pays $164.95. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$164.95
- Los Angeles, CA · California$164.57−$0.38
- Washington, DC area · District of Columbia$178.26+$13.31
- Miami, FL · Florida$207.78+$42.83
- Chicago, IL · Illinois$201.39+$36.44
- Manhattan, NY · New York$192.02+$27.07
- Alaska · Alaska$211.92+$46.97
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $150.36 |
| ArkansasArkansas | — | $148.61 |
| ArizonaArizona | — | $160.37 |
| Bakersfield, CACalifornia | — | $158.60 |
| Chico, CACalifornia | — | $156.37 |
| El Centro, CACalifornia | — | $156.51 |
| Fresno, CACalifornia | — | $156.37 |
| Hanford, CACalifornia | — | $156.37 |
| Madera, CACalifornia | — | $156.37 |
| Merced, CACalifornia | — | $156.37 |
| Modesto, CACalifornia | — | $156.37 |
| Napa, CACalifornia | — | $165.82 |
| Oxnard, CACalifornia | — | $161.92 |
| Redding, CACalifornia | — | $156.37 |
| Rest of CaliforniaCalifornia | — | $156.37 |
| Riverside, CACalifornia | — | $165.17 |
| Sacramento, CACalifornia | — | $160.05 |
| Salinas, CACalifornia | — | $159.38 |
| San Diego, CACalifornia | — | $160.24 |
| Marin County, CACalifornia | — | $170.20 |
| San Francisco, CACalifornia | — | $169.27 |
| San Benito County, CACalifornia | — | $174.75 |
| Santa Clara County, CACalifornia | — | $170.94 |
| San Luis Obispo, CACalifornia | — | $157.32 |
| Santa Cruz, CACalifornia | — | $159.46 |
| Santa Maria, CACalifornia | — | $159.19 |
| Santa Rosa, CACalifornia | — | $160.79 |
| Stockton, CACalifornia | — | $156.37 |
| Vallejo, CACalifornia | — | $164.47 |
| Visalia, CACalifornia | — | $156.37 |
| Yuba City, CACalifornia | — | $156.37 |
| ColoradoColorado | — | $161.80 |
| ConnecticutConnecticut | — | $174.76 |
| DelawareDelaware | — | $162.55 |
| Fort Lauderdale, FLFlorida | — | $187.42 |
| Rest of FloridaFlorida | — | $177.81 |
| Atlanta, GAGeorgia | — | $171.20 |
| Rest of GeorgiaGeorgia | — | $167.88 |
| Hawaii, Guam, HIHawaii | — | $156.49 |
| IowaIowa | — | $146.61 |
| IdahoIdaho | — | $148.80 |
| East St. Louis, ILIllinois | — | $191.01 |
| Rest of IllinoisIllinois | — | $178.50 |
| Suburban Chicago, ILIllinois | — | $187.55 |
| IndianaIndiana | — | $149.31 |
| KansasKansas | — | $149.30 |
| KentuckyKentucky | — | $160.23 |
| New Orleans, LALouisiana | — | $167.42 |
| Rest of LouisianaLouisiana | — | $161.31 |
| Metropolitan Boston, MAMassachusetts | — | $171.00 |
| Rest of MassachusettsMassachusetts | — | $162.46 |
| Baltimore area, MDMaryland | — | $174.95 |
| Rest of MarylandMaryland | — | $164.17 |
| Rest of MaineMaine | — | $152.88 |
| Southern Maine, MEMaine | — | $154.70 |
| Detroit, MIMichigan | — | $183.02 |
| Rest of MichiganMichigan | — | $166.62 |
| MinnesotaMinnesota | — | $146.36 |
| Metropolitan Kansas City, MOMissouri | — | $163.03 |
| Metropolitan St. Louis, MOMissouri | — | $164.00 |
| Rest of MissouriMissouri | — | $161.25 |
| MississippiMississippi | — | $154.79 |
| North CarolinaNorth Carolina | — | $153.64 |
| North DakotaNorth Dakota | — | $148.73 |
| NebraskaNebraska | — | $146.27 |
| New HampshireNew Hampshire | — | $162.48 |
| Northern New JerseyNew Jersey | — | $177.67 |
| Rest of New JerseyNew Jersey | — | $174.31 |
| New MexicoNew Mexico | — | $168.68 |
| NevadaNevada | — | $160.45 |
| NYC suburbs and Long Island, NYNew York | — | $200.04 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $178.05 |
| Queens, NYNew York | — | $188.51 |
| Rest of New YorkNew York | — | $155.76 |
| OhioOhio | — | $163.30 |
| OklahomaOklahoma | — | $156.53 |
| Portland, OROregon | — | $162.28 |
| Rest of OregonOregon | — | $156.78 |
| Metropolitan Philadelphia, PAPennsylvania | — | $173.27 |
| Rest of PennsylvaniaPennsylvania | — | $161.69 |
| Puerto RicoPuerto Rico | — | $164.83 |
| Rhode IslandRhode Island | — | $164.97 |
| South CarolinaSouth Carolina | — | $159.22 |
| South DakotaSouth Dakota | — | $146.81 |
| TennesseeTennessee | — | $150.31 |
| Austin, TXTexas | — | $163.39 |
| Beaumont, TXTexas | — | $161.07 |
| Brazoria, TXTexas | — | $159.70 |
| Dallas, TXTexas | — | $162.06 |
| Fort Worth, TXTexas | — | $162.20 |
| Galveston, TXTexas | — | $161.06 |
| Houston, TXTexas | — | $176.07 |
| Rest of TexasTexas | — | $161.22 |
| UtahUtah | — | $160.88 |
| VirginiaVirginia | — | $156.57 |
| Virgin Islands, VIUnited States Virgin Islands | — | $164.83 |
| VermontVermont | — | $151.25 |
| Rest of WashingtonWashington | — | $161.13 |
| King County, WAWashington | — | $170.77 |
| WisconsinWisconsin | — | $145.12 |
| West VirginiaWest Virginia | — | $173.92 |
| WyomingWyoming | — | $157.88 |
33992 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 33992 rate is calculated
Each of 33992’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 · 33992
RVUs × geographic indexes × conversion factor
Work3.46
3.46 RVUs× 1.000 GPCI
Practice expense0.66
0.66 RVUs× 1.000 GPCI
Malpractice0.82
0.82 RVUs× 1.000 GPCI
Adjusted RVUs
4.9400
Conversion factor
$33.4009
Medicare rate
$165.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
4,176
- Code
- 33992
- Physician work
- 3.46
- Practice expense
- 0.66
- Malpractice
- 0.82
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.46 | × 1.000 | 3.4600 |
| Practice expense | 0.66 | × 1.000 | 0.6600 |
| Malpractice | 0.82 | × 0.998 | 0.8184 |
| Total RVUs | 4.9384 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Montana$164.95
Facility: (3.46 × 1 + 0.66 × 1 + 0.82 × 0.998) × $33.4009 = $164.95
Payment rules and modifiers for 33992
The CMS indicators that decide how 33992 is paid alongside other services.
CMS payment indicators · 33992
VAD removal, percutaneous left-heart device
| 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
33992 without 51 · national facility
$165.00
VAD removal, percutaneous left-heart device
33992-51 · Second procedure: 50%
$82.50
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%).
How 33992 has changed in Montana
33992 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $164.95 | RVU26D |
| 2026-07-01 | Not available in this setting | $164.95 | RVU26C |
| 2026-04-01 | Not available in this setting | $164.95 | RVU26B |
| 2026-01-01 | Not available in this setting | $164.95 | RVU26A |
| 2025-10-01 | Not available in this setting | $177.65 | RVU25D |
| 2025-07-01 | Not available in this setting | $177.65 | RVU25C |
| 2025-04-01 | Not available in this setting | $177.65 | RVU25B |
| 2025-01-01 | Not available in this setting | $177.65 | RVU25A |
| 2024-10-01 | Not available in this setting | $182.49 | RVU24D |
| 2024-07-01 | Not available in this setting | $182.49 | RVU24C |
| 2024-04-01 | Not available in this setting | $182.49 | RVU24B |
| 2024-03-09 | Not available in this setting | $182.49 | RVU24AR |
| 2024-01-01 | Not available in this setting | $179.51 | RVU24A |
| 2023-10-01 | Not available in this setting | $184.77 | RVU23D |
| 2023-07-01 | Not available in this setting | $184.77 | RVU23C |
| 2023-04-01 | Not available in this setting | $184.77 | RVU23B |
| 2023-01-01 | Not available in this setting | $184.77 | RVU23A |
| 2022-10-01 | Not available in this setting | $191.06 | RVU22D |
| 2022-07-01 | Not available in this setting | $191.06 | RVU22C |
| 2022-04-01 | Not available in this setting | $191.06 | RVU22B |
| 2022-01-01 | Not available in this setting | $191.06 | RVU22A |
| 2021-10-01 | Not available in this setting | $190.94 | RVU21D |
| 2021-07-01 | Not available in this setting | $190.94 | RVU21C |
| 2021-04-01 | Not available in this setting | $190.94 | RVU21B |
| 2021-01-01 | Not available in this setting | $190.94 | RVU21A |
| 2020-10-01 | Not available in this setting | $217.59 | RVU20D |
| 2020-07-01 | Not available in this setting | $217.59 | RVU20C |
| 2020-04-01 | Not available in this setting | $217.59 | RVU20B |
| 2020-01-01 | Not available in this setting | $217.59 | RVU20A |
| 2019-10-01 | Not available in this setting | $228.13 | RVU19D |
| 2019-07-01 | Not available in this setting | $228.13 | RVU19C |
| 2019-04-01 | Not available in this setting | $228.13 | RVU19B |
| 2019-01-01 | Not available in this setting | $228.13 | RVU19A |
| 2018-10-01 | Not available in this setting | $228.83 | RVU18D |
| 2018-07-01 | Not available in this setting | $228.83 | RVU18C |
| 2018-04-01 | Not available in this setting | $228.83 | RVU18B |
| 2018-01-01 | Not available in this setting | $228.83 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $222.68 | RVU17D |
| 2017-07-01 | Not available in this setting | $222.68 | RVU17C |
| 2017-04-01 | Not available in this setting | $222.68 | RVU17B |
| 2017-01-01 | Not available in this setting | $222.68 | RVU17A |
| 2016-10-01 | Not available in this setting | $223.98 | RVU16D |
| 2016-07-01 | Not available in this setting | $223.98 | RVU16C |
| 2016-04-01 | Not available in this setting | $223.98 | RVU16B |
| 2016-01-01 | Not available in this setting | $223.98 | RVU16A |
| 2015-10-01 | Not available in this setting | $231.42 | RVU15D |
| 2015-07-01 | Not available in this setting | $231.42 | RVU15C |
| 2015-04-01 | Not available in this setting | $230.27 | RVU15B |
| 2015-01-01 | Not available in this setting | $230.27 | RVU15A |
| 2014-10-01 | Not available in this setting | $219.60 | RVU14D |
| 2014-07-01 | Not available in this setting | $219.60 | RVU14C |
| 2014-04-01 | Not available in this setting | $219.60 | RVU14B |
| 2014-01-01 | Not available in this setting | $219.60 | RVU14A |
| 2013-10-01 | Not available in this setting | $212.36 | RVU13D |
| 2013-07-01 | Not available in this setting | $212.36 | RVU13C |
| 2013-04-01 | Not available in this setting | $212.36 | RVU13B |
| 2013-01-01 | Not available in this setting | $212.36 | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
33992 billing questions
How is removal distinguished from repositioning?
Report 33992 when the percutaneous left-heart VAD is removed. Code 33993 describes repositioning a percutaneous right- or left-heart VAD, not removal.
Is 33992 used for VAD insertion?
No. Codes 33990 and 33991 describe percutaneous left-heart VAD insertion, with different access configurations; 33992 describes removal.
When does 33997 apply instead?
Use 33997 for removal of a percutaneous right-heart VAD. Code 33992 is specific to a percutaneous left-heart VAD.
Can modifier 50 be used for this removal?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the multiple procedure rule affect payment?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction.
What documentation supports reporting 33992?
Document that the device was a percutaneous left-heart VAD and that it was removed. The record should distinguish removal from repositioning or removal of a right-heart device.
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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