Billing code 33269: LAA exclusionMedicare rate & RVUs

Medicare pays $795.94 for 33269 nationally in a facility.

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

What 33269 covers

This code describes surgical exclusion of the left atrial appendage through a thoracoscopic approach. A cardiac surgeon typically performs the procedure in an operating room, using thoracoscopic access to close off the appendage from outside the heart; methods may include clipping or ligation. The code distinguishes this minimally invasive surgical approach from open exclusion and catheter-based closure. It may be performed as a stand-alone operation or alongside other cardiac surgery when the thoracoscopic approach is used for the appendage exclusion.

Select the code based on the documented thoracoscopic approach and the work to exclude the appendage, not merely because the patient has atrial fibrillation or an appendage device. The operative report should identify the approach and the exclusion method. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code’s descriptor and anatomy. 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 33269 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

33269 rates by state

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

How the 33269 rate is calculated

Each of 33269’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 33269

33269 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

33269 compared with similar codes

How to choose

33267LAA exclusion

Choose 33269 for thoracoscopic appendage exclusion and 33267 for the open approach.

33268LAA exclusion

33268 is for open appendage exclusion during another open cardiac procedure; 33269 identifies thoracoscopic exclusion.

33340Appendage closure

33340 describes transcatheter appendage closure with an endocardial implant, not thoracoscopic surgical exclusion.

Codes related to 33269

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

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