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Billing code 33256: Atrial ablationMedicare rate & RVUs

Reports extensive surgical ablation and atrial reconstruction, such as a maze procedure, when performed with cardiopulmonary bypass.

CMS RVU26DEffective Oct 1, 2026109 payment localities81 Medicare services in 2024

Medicare pays $1,827.03 for 33256 nationally in a facility.

Medicare rate · 33256

Atrial ablation

Swap in your local Medicare rate.

Work RVUs
34.03
Total RVUs
54.70
Global days
090

National rate · 2026

$1,827.03

Facility setting, before claim adjustments.

See every locality for 33256 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 33256 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 33256 covers

This code describes extensive surgical ablation and reconstruction of atrial tissue, commonly performed to treat atrial fibrillation with a maze-type lesion pattern. A cardiothoracic surgeon performs the open operation in a hospital setting using cardiopulmonary bypass. The operative report should establish the extent of the atrial work and document bypass use; a limited lesion set or an operation performed without bypass points to a different code in the family.

Report the service for the atrial ablation itself, with documentation of the lesion pattern, operative approach, and bypass. It may be performed during a broader cardiac operation, but the standard multiple-procedure reduction applies when other procedures are performed in the same session: the highest-valued procedure is paid in full and the others at 50%. The 90-day global includes the day-before preoperative visit and related postoperative care during the period. Report the atrial work as one operation rather than using modifier 50. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment is 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.

Where 33256 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

33256 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,656.61
Alaska*Unavailable$2,300.30
ArizonaUnavailable$1,774.87
ArkansasUnavailable$1,636.04
AtlantaUnavailable$1,891.85
AustinUnavailable$1,822.52
BakersfieldUnavailable$1,782.33
Baltimore/Surr. CntysUnavailable$1,940.26
BeaumontUnavailable$1,770.07
BrazoriaUnavailable$1,772.47

33256 rates by state

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

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Local rates. Clear comparisons.

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View every state and territory as a table
33256 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 33256 rate is calculated

Each of 33256’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 · 33256

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 34.03Practice expense 12.52Malpractice 8.15

54.7000 adjusted RVUs×$33.4009 conversion factor=$1,827.03

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 33256

33256 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33256

Atrial ablation

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
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)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 33256

Atrial ablation

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

33256 without 51 · national facility

$1,827.03

Atrial ablation

33256-51 · Second procedure: 50%

$913.52

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

33256 compared with similar codes

Compare codes

33256 vs 33255 vs 33254 vs 33266: national Medicare rates

Swap in your local Medicare rate.

  • 33256
    Atrial ablation · 34.03 wRVU
    —
  • 33255
    Atrial ablation · 28.31 wRVU
    —
  • 33254
    Atrial ablation · 23.12 wRVU
    —
  • 33266
    Atrial ablation · 32.21 wRVU
    —

How to choose

33255Atrial ablation
Both cover extensive atrial ablation, but 33255 is for work without cardiopulmonary bypass; 33256 includes bypass.
33254Atrial ablation
33254 is for limited atrial ablation without bypass. 33256 requires extensive work performed with bypass.
33266Atrial ablation
33266 describes extensive endoscopic atrial ablation. 33256 describes extensive open surgical work with cardiopulmonary bypass.

Codes related to 33256

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

Codes related to 33256
CodeHow it relatesNational office range
Same family
33255Atrial ablationExtensive atrial ablation performed without cardiopulmonary bypass.No office rate
33254Atrial ablationLimited atrial ablation performed without cardiopulmonary bypass.No office rate
33257Atrial ablationLimited atrial ablation code in the bypass-related family.No office rate
33258Atrial ablationExtensive atrial ablation code in the related add-on family.No office rate
Used instead
33265Atrial ablationEndoscopic approach for limited atrial ablation.No office rate
33266Atrial ablationEndoscopic approach for extensive atrial ablation.No office rate

33256 billing questions

How is 33256 distinguished from 33255?

Both describe extensive atrial ablation, but 33256 is performed with cardiopulmonary bypass. Code 33255 is for extensive work without bypass.

When should a limited ablation code be considered?

Choose a limited code when the operative report supports a limited lesion set rather than extensive atrial ablation and reconstruction. Bypass use also affects which code applies.

Can 33256 be reported with another cardiac procedure?

It may be performed during the same session as another cardiac operation. The standard multiple-procedure reduction applies: the highest-valued procedure is paid in full and the others at 50%.

What documentation supports reporting 33256?

The operative report should describe the extent and pattern of atrial ablation or reconstruction and document cardiopulmonary bypass use.

What does the 90-day global include?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

Can assistant or co-surgeon services be paid?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.

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 33256PPRRVU2026_Oct_nonQPP.csv, line 3,879 (RVU26D)

Open CMS sourceHow we calculate rates

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