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Billing code 33496: Valve thrombus repairMedicare rate & RVUs

Open cardiac surgery with cardiopulmonary bypass to clear thrombus affecting an existing prosthetic heart valve when the valve is repaired rather than replaced.

CMS RVU26DEffective Oct 1, 2026109 payment localities23 Medicare services in 2024

Medicare pays $1,586.54 for 33496 nationally in a facility.

Medicare rate · 33496

Valve thrombus repair

Work RVUs
29.09
Total RVUs
47.50
Global days
090

National rate · 2026

$1,586.54

Facility setting, before claim adjustments.

See every locality for 33496 →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 33496 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 33496 covers

A cardiac surgeon uses cardiopulmonary bypass to address thrombus obstructing or impairing an implanted prosthetic heart valve. The operation treats the clot-related problem while retaining and repairing the prosthesis, rather than removing it for valve replacement. It is a facility-based cardiac surgery service, not a separately reported diagnostic or catheter-based clot treatment.

Report the code when the operative work addresses thrombus involving a prosthetic valve. The operative report should identify the affected valve, document the thrombus and the repair performed, and clarify whether the prosthesis was retained or replaced. Medicare 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. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation. 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 33496 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

33496 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,437.64
Alaska*Unavailable$1,992.49
ArizonaUnavailable$1,541.14
ArkansasUnavailable$1,419.64
AtlantaUnavailable$1,642.43
AustinUnavailable$1,584.05
BakersfieldUnavailable$1,550.50
Baltimore/Surr. CntysUnavailable$1,685.21
BeaumontUnavailable$1,535.63
BrazoriaUnavailable$1,539.59

33496 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
33496 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 33496 rate is calculated

Each of 33496’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 · 33496

RVUs × geographic indexes × conversion factor

Work29.09

29.09 RVUs× 1.000 GPCI

Practice expense11.43

11.43 RVUs× 1.000 GPCI

Malpractice6.98

6.98 RVUs× 1.000 GPCI

Adjusted RVUs

47.5000

Conversion factor

$33.4009

Medicare rate

$1,586.54

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 33496

33496 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33496

Valve thrombus 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 · 33496

Valve thrombus 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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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

33496 without 51 · national facility

$1,586.54

Valve thrombus repair

33496-51 · Second procedure: 50%

$793.27

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

33496 compared with similar codes

Compare codes · National

4 codes, side by side

  • 33496

    Valve thrombus repair29.09 wRVU

    Not priced

  • 33413

    Aortic valve replacement58.37 wRVU

    Not priced

  • 33430

    Mitral valve replacement49.66 wRVU

    Not priced

  • 33414

    Aortic valve repair38.39 wRVU

    Not priced

How to choose

33413Aortic valve replacement
This code addresses thrombus involving a prosthetic valve that is repaired and retained. Code 33413 is for aortic valve replacement, not clot-directed repair.
33430Mitral valve replacement
Use this code for thrombus-related repair of a retained prosthetic valve. Code 33430 applies when the mitral valve is replaced.
33414Aortic valve repair
Code 33414 concerns aortic valve repair; this code is specific to thrombus involving an existing prosthetic heart valve.

Codes related to 33496

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

Codes related to 33496
CodeHow it relatesNational office range
Used instead
33413Aortic valve replacementAortic valve replacement when the thrombus-damaged prosthesis is removed and replaced.No office rate
33430Mitral valve replacementMitral valve replacement when the operative plan is to exchange the prosthesis.No office rate
33465Valve replacementTricuspid valve replacement when the affected prosthesis is replaced.No office rate
33475Pulmonary valve replacementPulmonary valve replacement when the affected prosthesis is removed and replaced.No office rate

33496 billing questions

How is this code distinguished from a valve replacement code?

Use this code when surgery treats thrombus affecting a prosthetic valve and the valve is retained and repaired. If the surgeon removes the prosthesis and implants a replacement, select the applicable replacement code instead.

Does this code include replacement of the prosthetic valve?

No. It describes repair directed at the thrombus problem with the prosthesis retained; replacement is a different operative service.

What documentation supports reporting this service?

The operative report should identify the prosthetic valve involved, describe the thrombus and the repair, and make clear whether the prosthesis was retained or replaced.

How does the 90-day global period affect postoperative reporting?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. 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 33496PPRRVU2026_Oct_nonQPP.csv, line 3,971 (RVU26D)

Open CMS sourceHow we calculate rates

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