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CPT 33478: RVOT revisionMedicare rate & RVUs

Reports surgical revision of the right ventricular outflow tract when reconstruction or enlargement is performed together with pulmonary valve replacement.

CMS RVU26DEffective Oct 1, 2026109 payment localities38 Medicare services in 2024

Medicare pays $1,493.35 for 33478 nationally in a facility.

Medicare rate · 33478

RVOT revision

Swap in your local Medicare rate.

Work RVUs
26.85
Total RVUs
44.71
Global days
090

National rate · 2026

$1,493.35

Facility setting, before claim adjustments.

See every locality for 33478 →

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 33478 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 33478 covers

This code describes open surgical revision of the right ventricular outflow tract (RVOT) combined with pulmonary valve replacement. A cardiac surgeon may perform it for a patient with congenital heart disease who has a failing prior RVOT repair or conduit, pulmonary valve dysfunction, or both. A familiar clinical setting is reoperation after tetralogy of Fallot repair when the RVOT requires reconstruction and the pulmonary valve is replaced.

Report the code when the operative record supports both RVOT revision, with or without enlargement, and pulmonary valve replacement; isolated pulmonary valve replacement is distinguished from this combined service. Documentation should identify the treated outflow tract, the reconstruction performed, and the valve replacement. CMS assigns a 90-day global period, including the day-before preoperative visit and 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% multiple-procedure reduction. Modifier 50 is inappropriate. 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 33478 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

33478 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,349.12
Alaska*Unavailable$1,864.65
ArizonaUnavailable$1,449.38
ArkansasUnavailable$1,331.69
AtlantaUnavailable$1,547.30
AustinUnavailable$1,490.97
BakersfieldUnavailable$1,457.86
Baltimore/Surr. CntysUnavailable$1,588.23
BeaumontUnavailable$1,443.95
BrazoriaUnavailable$1,447.59

33478 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
33478 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 33478 rate is calculated

Each of 33478’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 · 33478

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 26.85Practice expense 11.11Malpractice 6.75

44.7100 adjusted RVUs×$33.4009 conversion factor=$1,493.35

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

Payment rules and modifiers for 33478

33478 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33478

RVOT revision

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 · 33478

RVOT revision

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

33478 without 51 · national facility

$1,493.35

RVOT revision

33478-51 · Second procedure: 50%

$746.68

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

33478 compared with similar codes

Compare codes

33478 vs 33476 vs 33475 vs 33477: national Medicare rates

Swap in your local Medicare rate.

  • 33478
    RVOT revision · 26.85 wRVU
    —
  • 33476
    Ventriculoplasty · 25.91 wRVU
    —
  • 33475
    Pulmonary valve replacement · 41.34 wRVU
    —
  • 33477
    Pulmonary valve implant · 24.38 wRVU
    —

How to choose

33476Ventriculoplasty
33476 describes RVOT revision, with or without enlargement, without pulmonary valve replacement. When replacement is performed with the revision, consider 33478.
33475Pulmonary valve replacement
33475 covers pulmonary valve replacement without the combined RVOT revision captured by 33478.
33477Pulmonary valve implant
33477 is a transcatheter pulmonary valve procedure. 33478 describes open surgical RVOT revision performed with pulmonary valve replacement.

Codes related to 33478

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

Codes related to 33478
CodeHow it relatesNational office range
Same family
33476VentriculoplastyRVOT revision without pulmonary valve replacement; valve replacement distinguishes 33478.No office rate
Used instead
33475Pulmonary valve replacementPulmonary valve replacement without the combined RVOT revision described by 33478.No office rate
33477Pulmonary valve implantTranscatheter pulmonary valve treatment rather than open surgical RVOT revision with valve replacement.No office rate

33478 billing questions

Can 33475 also be reported for the valve replacement?

The pulmonary valve replacement is part of the combined service described by 33478. Do not separately report 33475 for that same replacement.

When is 33476 a better fit?

Use 33476 for RVOT revision with or without enlargement when pulmonary valve replacement is not performed. The presence of pulmonary valve replacement distinguishes 33478.

What documentation supports 33478?

The operative report should describe the RVOT revision or enlargement and the pulmonary valve replacement. A record describing only valve replacement does not support the combined service.

Can modifier 50 be used for work on both sides?

No. Modifier 50 is inappropriate for this code; CMS does not apply a bilateral adjustment.

How are other procedures in the same session paid?

Under the CMS multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment may be made; 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 33478PPRRVU2026_Oct_nonQPP.csv, line 3,970 (RVU26D)

Open CMS sourceHow we calculate rates

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