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Billing code 33267: LAA exclusionMedicare rate & RVUs

Reports open surgical exclusion of the left atrial appendage as a standalone service, using a method such as suturing, stapling, or excision.

CMS RVU26DEffective Oct 1, 2026109 payment localities323 Medicare services in 2024

Medicare pays $988.67 for 33267 nationally in a facility.

Medicare rate · 33267

LAA exclusion

Swap in your local Medicare rate.

Work RVUs
18.04
Total RVUs
29.60
Global days
090

National rate · 2026

$988.67

Facility setting, before claim adjustments.

See every locality for 33267 → · 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 33267 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 33267 covers

The surgeon excludes the left atrial appendage through an open approach, using the method appropriate to the operation, such as suturing, stapling, or excision. This service is used in selected patients with atrial fibrillation as part of surgical stroke-risk management. Cardiothoracic surgeons typically perform it in an operating room, either as a standalone procedure or alongside other cardiac surgery; when it accompanies another cardiac procedure, the related add-on code distinguishes that circumstance.

Select this code for open LAA exclusion performed as a standalone service, not for a thoracoscopic approach or exclusion performed during another cardiac procedure. The operative report should identify the open approach, the appendage treated, the exclusion method, and whether another cardiac procedure was performed in the same session. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery 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 33267 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

33267 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$894.68
Alaska*Unavailable$1,238.99
ArizonaUnavailable$959.98
ArkansasUnavailable$883.32
AtlantaUnavailable$1,024.03
AustinUnavailable$986.82
BakersfieldUnavailable$965.12
Baltimore/Surr. CntysUnavailable$1,050.76
BeaumontUnavailable$956.73
BrazoriaUnavailable$958.79

33267 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
33267 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 33267 rate is calculated

Each of 33267’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 · 33267

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 18.04Practice expense 7.13Malpractice 4.43

29.6000 adjusted RVUs×$33.4009 conversion factor=$988.67

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

Payment rules and modifiers for 33267

33267 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33267

LAA exclusion

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 · 33267

LAA exclusion

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

33267 without 51 · national facility

$988.67

LAA exclusion

33267-51 · Second procedure: 50%

$494.34

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

33267 compared with similar codes

Compare codes

33267 vs 33268 vs 33269 vs 33254: national Medicare rates

Swap in your local Medicare rate.

  • 33267
    LAA exclusion · 18.04 wRVU
    —
  • 33268
    LAA exclusion · 2.44 wRVU
    —
  • 33269
    LAA exclusion · 13.95 wRVU
    —
  • 33254
    Atrial ablation · 23.12 wRVU
    —

How to choose

33268LAA exclusion
Both describe open LAA exclusion, but 33267 is for a standalone service; 33268 is used when exclusion is performed during another cardiac procedure.
33269LAA exclusion
Choose 33267 for open surgical access and 33269 for a thoracoscopic approach.
33254Atrial ablation
33254 reports limited atrial ablation, not LAA exclusion. Report 33267 only when the appendage itself is surgically excluded by an open approach.

Codes related to 33267

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

Codes related to 33267
CodeHow it relatesNational office range
Add-on codes
33268LAA exclusionAdd-on for open LAA exclusion performed during another cardiac procedure.No office rate
Used instead
33269LAA exclusionUse for LAA exclusion by a thoracoscopic approach instead of an open approach.No office rate
Often billed with
33254Atrial ablationLimited atrial ablation may be a distinct service during the same open cardiac operation.No office rate

33267 billing questions

When should 33267 be used instead of 33268?

Use 33267 for open LAA exclusion performed as a standalone service. Use 33268 when open LAA exclusion is performed during another cardiac procedure.

How does 33267 differ from 33269?

33267 describes an open approach. 33269 is for thoracoscopic LAA exclusion.

Can the LAA exclusion be reported with another cardiac procedure?

If open LAA exclusion is performed during another cardiac procedure, report the applicable add-on code, 33268, rather than 33267. Document the procedures and the operative approach.

What documentation supports reporting 33267?

The operative report should establish the open approach, the left atrial appendage treated, the exclusion method, and whether the service was standalone or performed during another cardiac procedure.

Can modifier 50 be reported, and can an assistant be paid?

Modifier 50 is inappropriate based on the descriptor and anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.

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 33267PPRRVU2026_Oct_nonQPP.csv, line 3,890 (RVU26D)

Open CMS sourceHow we calculate rates

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