No office rate
33420 is the closed-heart mitral valvotomy code. Report 33422 when the surgeon performs the open operation with cardiopulmonary bypass.
On this page
CMS RVU26D · Effective 2026-10-01
33422 Mitral valvotomy Medicare reimbursement rates
Reports open surgical division of fused mitral valve commissures under cardiopulmonary bypass to relieve stenosis while preserving the native valve. Compare 33422 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 33422?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 33422 pays more and less
Cardiac surgery
About 33422: Open mitral valvotomy with bypass
Reports open surgical division of fused mitral valve commissures under cardiopulmonary bypass to relieve stenosis while preserving the native valve.
A cardiac surgeon performs an open mitral valvotomy with cardiopulmonary bypass, directly addressing the stenotic valve and separating fused commissures to improve valve opening. This operation is used for selected patients with mitral stenosis when the native valve can be preserved; commissural fusion, often associated with rheumatic disease, is a typical finding. It is generally performed in a hospital operating room.
Choose this code for the open operation with bypass, not for a closed valvotomy, mitral valve repair, or valve replacement. The operative report should establish the open approach, use of bypass, stenotic pathology, and the valvotomy performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation. Team surgery is not permitted.
CMS billing rules for 33422
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU28.99 · 61%
- Practice expense (office) RVU11.60 · 24%
- Malpractice RVU6.96 · 15%
17
Medicare services in 2024 · #6003 by national volume
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.
33422 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
33425 describes mitral valve repair with annuloplasty. It is not the code for dividing fused commissures to relieve stenosis.
No office rate
33430 is for mitral valve replacement. 33422 preserves the native valve and opens it through valvotomy.
See how rates vary across the country
33422 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | 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 |
Compare 33422 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1438.89 |
| Alaska* | Office Unavailable | Facility $1993.16 |
| Arizona | Office Unavailable | Facility $1542.73 |
| Arkansas | Office Unavailable | Facility $1420.83 |
| Atlanta | Office Unavailable | Facility $1644.04 |
| Austin | Office Unavailable | Facility $1586.12 |
| Bakersfield | Office Unavailable | Facility $1552.91 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $1687.08 |
| Beaumont | Office Unavailable | Facility $1536.84 |
| Brazoria | Office Unavailable | Facility $1541.33 |
| Chicago | Office Unavailable | Facility $1897.98 |
| Chico | Office Unavailable | Facility $1534.00 |
| Colorado | Office Unavailable | Facility $1573.72 |
| Connecticut | Office Unavailable | Facility $1686.23 |
| Dallas | Office Unavailable | Facility $1562.37 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $1735.74 |
| Delaware | Office Unavailable | Facility $1564.93 |
| Detroit | Office Unavailable | Facility $1734.13 |
| East St. Louis | Office Unavailable | Facility $1792.94 |
| El Centro | Office Unavailable | Facility $1535.17 |
| Fort Lauderdale | Office Unavailable | Facility $1781.09 |
| Fort Worth | Office Unavailable | Facility $1561.51 |
| Fresno | Office Unavailable | Facility $1534.00 |
| Galveston | Office Unavailable | Facility $1553.26 |
| Hanford-Corcoran | Office Unavailable | Facility $1534.00 |
| Hawaii, Guam | Office Unavailable | Facility $1543.42 |
| Houston | Office Unavailable | Facility $1680.66 |
| Idaho | Office Unavailable | Facility $1434.70 |
| Indiana | Office Unavailable | Facility $1440.44 |
| Iowa | Office Unavailable | Facility $1415.10 |
| Kansas | Office Unavailable | Facility $1435.71 |
| Kentucky | Office Unavailable | Facility $1525.45 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1620.71 |
| Madera | Office Unavailable | Facility $1534.00 |
| Manhattan | Office Unavailable | Facility $1849.18 |
| Merced | Office Unavailable | Facility $1534.00 |
| Metropolitan Boston | Office Unavailable | Facility $1677.51 |
| Metropolitan Kansas City | Office Unavailable | Facility $1559.23 |
| Metropolitan Philadelphia | Office Unavailable | Facility $1666.39 |
| Metropolitan St. Louis | Office Unavailable | Facility $1570.08 |
| Miami | Office Unavailable | Facility $1959.55 |
| Minnesota | Office Unavailable | Facility $1435.79 |
| Mississippi | Office Unavailable | Facility $1473.68 |
| Modesto | Office Unavailable | Facility $1534.00 |
| Montana** | Office Unavailable | Facility $1587.75 |
| Napa | Office Unavailable | Facility $1658.05 |
| Nebraska | Office Unavailable | Facility $1413.78 |
| Nevada** | Office Unavailable | Facility $1549.78 |
| New Hampshire | Office Unavailable | Facility $1575.04 |
| New Mexico | Office Unavailable | Facility $1602.78 |
| New Orleans | Office Unavailable | Facility $1596.97 |
| North Carolina | Office Unavailable | Facility $1478.33 |
| North Dakota** | Office Unavailable | Facility $1450.13 |
| Northern Nj | Office Unavailable | Facility $1727.02 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $1922.64 |
| Ohio | Office Unavailable | Facility $1556.36 |
| Oklahoma | Office Unavailable | Facility $1494.91 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1598.20 |
| Portland | Office Unavailable | Facility $1587.20 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $1717.41 |
| Puerto Rico | Office Unavailable | Facility $1588.99 |
| Queens | Office Unavailable | Facility $1823.45 |
| Redding | Office Unavailable | Facility $1534.00 |
| Rest Of California | Office Unavailable | Facility $1534.00 |
| Rest Of Florida | Office Unavailable | Facility $1688.10 |
| Rest Of Georgia | Office Unavailable | Facility $1591.00 |
| Rest Of Illinois | Office Unavailable | Facility $1685.39 |
| Rest Of Louisiana | Office Unavailable | Facility $1533.89 |
| Rest Of Maine | Office Unavailable | Facility $1469.34 |
| Rest Of Maryland | Office Unavailable | Facility $1583.48 |
| Rest Of Massachusetts | Office Unavailable | Facility $1577.05 |
| Rest Of Michigan | Office Unavailable | Facility $1584.49 |
| Rest Of Missouri | Office Unavailable | Facility $1528.70 |
| Rest Of New Jersey | Office Unavailable | Facility $1685.14 |
| Rest Of New York | Office Unavailable | Facility $1499.80 |
| Rest Of Oregon | Office Unavailable | Facility $1517.62 |
| Rest Of Pennsylvania | Office Unavailable | Facility $1543.66 |
| Rest Of Texas | Office Unavailable | Facility $1545.90 |
| Rest Of Washington | Office Unavailable | Facility $1565.78 |
| Rhode Island | Office Unavailable | Facility $1594.29 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1608.66 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1578.36 |
| Salinas | Office Unavailable | Facility $1571.97 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1586.73 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1713.29 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1705.38 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1758.11 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1725.80 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1550.66 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1583.98 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1571.78 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1597.73 |
| Seattle (King Cnty) | Office Unavailable | Facility $1682.04 |
| South Carolina | Office Unavailable | Facility $1523.90 |
| South Dakota** | Office Unavailable | Facility $1433.85 |
| Southern Maine | Office Unavailable | Facility $1498.94 |
| Stockton | Office Unavailable | Facility $1534.00 |
| Suburban Chicago | Office Unavailable | Facility $1784.92 |
| Tennessee | Office Unavailable | Facility $1445.32 |
| Utah | Office Unavailable | Facility $1541.25 |
| Vallejo | Office Unavailable | Facility $1646.66 |
| Vermont | Office Unavailable | Facility $1469.50 |
| Virgin Islands | Office Unavailable | Facility $1588.99 |
| Virginia | Office Unavailable | Facility $1513.28 |
| Visalia | Office Unavailable | Facility $1534.00 |
| West Virginia | Office Unavailable | Facility $1637.65 |
| Wisconsin | Office Unavailable | Facility $1411.07 |
| Wyoming** | Office Unavailable | Facility $1527.77 |
| Yuba City | Office Unavailable | Facility $1534.00 |
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33422 billing questions
How does 33422 differ from 33420?
33422 describes open mitral valvotomy with cardiopulmonary bypass. 33420 is the closed-heart mitral valvotomy code.
When is mitral repair or replacement reported instead?
Use a repair code when the operation reconstructs the valve rather than dividing fused commissures. Use a replacement code when the native valve is removed and replaced.
What should the operative report support?
Document the open approach, cardiopulmonary bypass, mitral stenosis, and the valve-opening procedure performed. The diagnosis alone does not establish that this operation was done.
Can modifier 50 be reported?
No. The bilateral adjustment does not apply to this single mitral valve operation, and modifier 50 is inappropriate.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. The 90-day global period includes related postoperative care.
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.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,94833419,,Repair tcat mitral valve,A,,7.73,1.47,NA,1.47,,1.82,11.02,11.02,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,9493341F,,Mammo assess negative docd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3,95033420,,Revision of mitral valve,A,,25.15,10.36,NA,10.36,,6.02,41.53,41.53,0,090,0.09,0.84,0.07,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,95133422,,Revision of mitral valve,A,,28.99,11.60,NA,11.60,,6.96,47.55,47.55,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,95233425,,Repair of mitral valve,A,,48.71,15.64,NA,15.64,,11.99,76.34,76.34,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,95333426,,Repair of mitral valve,A,,42.20,14.19,NA,14.19,,10.43,66.82,66.82,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,95433427,,Repair of mitral valve,A,,43.71,13.84,NA,13.84,,10.51,68.06,68.06,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00