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Billing code 33418: Mitral valve repairMedicare rate & RVUs

Reports catheter-based repair of mitral regurgitation using an initial prosthesis, including transseptal access when performed, during a structural heart procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities10.8K Medicare services in 2024

Medicare pays $1,580.86 for 33418 nationally in a facility.

Medicare rate · 33418

Mitral valve repair

Swap in your local Medicare rate.

Work RVUs
31.44
Total RVUs
47.33
Global days
090

National rate · 2026

$1,580.86

Facility setting, before claim adjustments.

See every locality for 33418 → · 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 33418 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 33418 covers

This code covers a catheter-based mitral valve repair, commonly a transcatheter edge-to-edge procedure for mitral regurgitation. A structural heart team, typically including an interventional cardiologist and cardiac surgeon, performs it in a hospital catheterization laboratory or hybrid operating room. The catheter is advanced to the mitral valve, often through transseptal access, and a prosthesis is used to improve leaflet coaptation. The code includes the transseptal puncture when performed.

Report 33418 for the initial prosthesis; report 33419 for each additional prosthesis. The operative report should support the percutaneous approach, mitral valve repair, and prosthesis use. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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 33418 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

33418 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,437.84
Alaska*Unavailable$2,012.87
ArizonaUnavailable$1,536.37
ArkansasUnavailable$1,420.66
AtlantaUnavailable$1,638.42
AustinUnavailable$1,571.06
BakersfieldUnavailable$1,530.91
Baltimore/Surr. CntysUnavailable$1,677.11
BeaumontUnavailable$1,537.81
BrazoriaUnavailable$1,532.13

33418 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
33418 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 33418 rate is calculated

Each of 33418’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 · 33418

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 31.44Practice expense 8.46Malpractice 7.43

47.3300 adjusted RVUs×$33.4009 conversion factor=$1,580.86

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

Payment rules and modifiers for 33418

33418 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33418

Mitral valve repair

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 · 33418

Mitral valve repair

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

33418 without 51 · national facility

$1,580.86

Mitral valve repair

33418-51 · Second procedure: 50%

$790.43

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

33418 compared with similar codes

Compare codes

33418 vs 33419 vs 33425 vs 33426 vs 33430: national Medicare rates

Swap in your local Medicare rate.

  • 33418
    Mitral valve repair · 31.44 wRVU
    —
  • 33419
    Mitral repair · 7.73 wRVU
    —
  • 33425
    Mitral valve repair · 48.71 wRVU
    —
  • 33426
    Mitral valve repair · 42.2 wRVU
    —
  • 33430
    Mitral valve replacement · 49.66 wRVU
    —

How to choose

33419Mitral repair
33418 represents the initial prosthesis in the transcatheter repair; 33419 is used for each additional prosthesis.
33425Mitral valve repair
Use 33418 for percutaneous transcatheter mitral repair. Code 33425 describes open surgical mitral valve repair.
33426Mitral valve repair
Both codes concern mitral valve repair, but 33418 is for the percutaneous transcatheter approach and 33426 is an open surgical repair.
33430Mitral valve replacement
33418 repairs the mitral valve by a transcatheter approach; 33430 describes mitral valve replacement.

Codes related to 33418

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

Codes related to 33418
CodeHow it relatesNational office range
Add-on codes
33419Mitral repairAdd-on code for each additional prosthesis during the transcatheter mitral repair.No office rate
Often billed with
93355TEE guidanceMay be reported for transesophageal echocardiographic guidance of a structural heart intervention.No office rate
Used instead
33425Mitral valve repairOpen surgical mitral valve repair rather than percutaneous transcatheter repair.No office rate
33426Mitral valve repairOpen mitral valve repair using a different surgical method.No office rate
33427Mitral valve repairOpen mitral valve repair using a different surgical method.No office rate

33418 billing questions

When is 33419 reported with 33418?

Report 33418 for the initial prosthesis and 33419 for each additional prosthesis. The operative report should support the number of prostheses used.

Is transseptal puncture separately reported?

Transseptal puncture, when performed for this repair, is included in 33418.

How does 33418 differ from 33425 through 33427?

33418 describes a percutaneous transcatheter repair. Codes 33425 through 33427 describe open surgical mitral valve repair procedures.

Should modifier 50 be appended?

No. Bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

Can an assistant or co-surgeon be reported?

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

What happens when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.

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 33418PPRRVU2026_Oct_nonQPP.csv, line 3,947 (RVU26D)

Open CMS sourceHow we calculate rates

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