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Billing code 33426: Mitral valve repairMedicare rate & RVUs

Open mitral valve repair with a prosthetic annuloplasty ring on cardiopulmonary bypass, reported when the native valve is repaired rather than replaced.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.9K Medicare services in 2024

Medicare pays $2,231.85 for 33426 nationally in a facility.

Medicare rate · 33426

Mitral valve repair

Swap in your local Medicare rate.

Work RVUs
42.2
Total RVUs
66.82
Global days
090

National rate · 2026

$2,231.85

Facility setting, before claim adjustments.

See every locality for 33426 → · 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 33426 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 33426 covers

A cardiac surgeon uses this service for open repair of the native mitral valve on cardiopulmonary bypass, placing a prosthetic ring to reshape or support the valve annulus. It is used for conditions such as mitral regurgitation when the surgeon repairs the valve rather than replacing it. The operation is generally performed in a hospital operating room; the ring placement is part of the repair service.

Select this code when the operative report documents mitral valve repair with a prosthetic ring. Repair without a ring is coded differently, and extensive reconstruction has a separate code. The service has a 90-day global period that includes the day-before preoperative visit and related postoperative care for 90 days. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures receive the standard multiple-procedure reduction. Modifier 50 is inappropriate for this single-valve service. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation. CMS does not permit team-surgery payment for this code.

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 33426 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

33426 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,021.41
Alaska*Unavailable$2,811.00
ArizonaUnavailable$2,166.99
ArkansasUnavailable$1,996.06
AtlantaUnavailable$2,313.68
AustinUnavailable$2,222.44
BakersfieldUnavailable$2,167.92
Baltimore/Surr. CntysUnavailable$2,371.56
BeaumontUnavailable$2,164.46
BrazoriaUnavailable$2,162.22

33426 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.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
33426 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 33426 rate is calculated

Each of 33426’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 · 33426

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 42.20Practice expense 14.19Malpractice 10.43

66.8200 adjusted RVUs×$33.4009 conversion factor=$2,231.85

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

Payment rules and modifiers for 33426

33426 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33426

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 · 33426

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

33426 without 51 · national facility

$2,231.85

Mitral valve repair

33426-51 · Second procedure: 50%

$1,115.93

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

33426 compared with similar codes

Compare codes

33426 vs 33425 vs 33427 vs 33430 vs 33418: national Medicare rates

Swap in your local Medicare rate.

  • 33426
    Mitral valve repair · 42.2 wRVU
    —
  • 33425
    Mitral valve repair · 48.71 wRVU
    —
  • 33427
    Mitral valve repair · 43.71 wRVU
    —
  • 33430
    Mitral valve replacement · 49.66 wRVU
    —
  • 33418
    Mitral valve repair · 31.44 wRVU
    —

How to choose

33425Mitral valve repair
Both describe open mitral repair on bypass. Choose 33426 when a prosthetic ring is used; choose 33425 when the repair is performed without one.
33427Mitral valve repair
This code identifies repair with a prosthetic ring. Code 33427 is for extensive reconstruction, based on the operative technique documented.
33430Mitral valve replacement
33426 preserves and repairs the native mitral valve with a ring. Use 33430 when the operation replaces the valve instead.
33418Mitral valve repair
33418 is a catheter-based mitral repair approach. This code is for open repair on cardiopulmonary bypass with a prosthetic ring.

Codes related to 33426

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

Codes related to 33426
CodeHow it relatesNational office range
Same family
33425Mitral valve repairRelated open mitral repair on bypass performed without a prosthetic ring.No office rate
33427Mitral valve repairFor extensive mitral reconstruction; distinguish the operative technique documented.No office rate
Used instead
33418Mitral valve repairCatheter-based mitral repair is an alternative to open repair with an annuloplasty ring.No office rate
33430Mitral valve replacementUse for mitral valve replacement rather than repair of the native valve.No office rate

33426 billing questions

How is this code distinguished from 33425?

Use this code when the mitral repair includes a prosthetic annuloplasty ring. Code 33425 describes the related repair without a ring.

Is cardiopulmonary bypass separately reported?

The repair service is performed on cardiopulmonary bypass; bypass is part of this operative service, not a separate unit of mitral repair.

Can an assistant surgeon or co-surgeon be reported?

CMS permits assistant-at-surgery payment for this code. Co-surgeon payment requires supporting documentation, and team-surgery payment is unavailable.

What does the 90-day global period include?

It includes the day-before preoperative visit and 90 days of related postoperative care. The global period is tied to the repair operation.

Should modifier 50 or separate right- and left-sided units be used?

No. This is a single mitral-valve operation, not a bilateral procedure; modifier 50 and separate side-based units are inappropriate.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure 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 33426PPRRVU2026_Oct_nonQPP.csv, line 3,953 (RVU26D)

Open CMS sourceHow we calculate rates

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