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Billing code 33503: Coronary repairMedicare rate & RVUs

Reports surgical bypass grafting to restore blood flow when a coronary artery arises anomalously from the pulmonary artery, as in ALCAPA.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,277.58 for 33503 nationally in a facility.

Medicare rate · 33503

Coronary repair

Swap in your local Medicare rate.

Work RVUs
21.95
Total RVUs
38.25
Global days
090

National rate · 2026

$1,277.58

Facility setting, before claim adjustments.

See every locality for 33503 → · 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 33503 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 33503 covers

This operation creates a bypass graft to supply blood to a coronary artery that originates from the pulmonary artery. It is used for congenital coronary anomalies, including anomalous left coronary artery from the pulmonary artery (ALCAPA), which can impair oxygen delivery to the heart muscle. A cardiothoracic or congenital heart surgeon performs the repair in an operating room; the operative report should establish the anomalous origin and describe the graft-based repair.

Report this code for the bypass repair, rather than a code for a different correction technique or routine bypass for acquired coronary disease. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. If other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment requires medical-necessity documentation; 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 33503 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

33503 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,152.46
Alaska*Unavailable$1,584.61
ArizonaUnavailable$1,239.84
ArkansasUnavailable$1,137.28
AtlantaUnavailable$1,322.67
AustinUnavailable$1,278.86
BakersfieldUnavailable$1,253.83
Baltimore/Surr. CntysUnavailable$1,359.35
BeaumontUnavailable$1,232.09
BrazoriaUnavailable$1,239.58

33503 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
33503 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 33503 rate is calculated

Each of 33503’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 · 33503

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 21.95Practice expense 10.77Malpractice 5.53

38.2500 adjusted RVUs×$33.4009 conversion factor=$1,277.58

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

Payment rules and modifiers for 33503

33503 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33503

Coronary 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)0Not paid without supporting documentation.
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 · 33503

Coronary 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

33503 without 51 · national facility

$1,277.58

Coronary repair

33503-51 · Second procedure: 50%

$638.79

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

33503 compared with similar codes

Compare codes

33503 vs 33502 vs 33504 vs 33510 vs 33533: national Medicare rates

Swap in your local Medicare rate.

  • 33503
    Coronary repair · 21.95 wRVU
    —
  • 33502
    Coronary repair · 21.3 wRVU
    —
  • 33504
    Coronary repair · 24.82 wRVU
    —
  • 33510
    Coronary bypass · 34.11 wRVU
    —
  • 33533
    Arterial CABG · 32.91 wRVU
    —

How to choose

33502Coronary repair
Use 33503 when the anomalous coronary artery is repaired with bypass grafting. Code 33502 represents the ligation-based repair approach.
33504Coronary repair
Both concern an anomalous coronary artery arising from the pulmonary artery, but 33504 represents a different repair technique. Follow the operative description rather than treating the codes as interchangeable.
33510Coronary bypass
33510 is for single venous-graft CABG in a different clinical context. 33503 is specific to bypass repair of a coronary artery with anomalous pulmonary origin.
33533Arterial CABG
33533 describes single arterial-graft CABG for a different clinical context; 33503 addresses the congenital anomalous-origin repair.

Codes related to 33503

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

Codes related to 33503
CodeHow it relatesNational office range
Same family
33502Coronary repairLigation-based repair of an anomalous coronary artery from the pulmonary artery.No office rate
33504Coronary repairA distinct repair approach for an anomalous coronary artery from the pulmonary artery.No office rate
Used instead
33510Coronary bypassSingle venous-graft CABG code for a different bypass context, generally acquired coronary disease.No office rate
33533Arterial CABGSingle arterial-graft CABG code for a different bypass context, generally acquired coronary disease.No office rate

33503 billing questions

When is 33503 different from 33502?

33503 describes bypass grafting to address a coronary artery arising from the pulmonary artery. Select 33502 when the documented repair is the ligation-based technique instead.

How does 33503 differ from 33504?

These codes distinguish surgical approaches to an anomalous coronary artery from the pulmonary artery. Use 33503 for a bypass graft repair; use 33504 when the operative report supports its distinct repair technique.

Can modifier 50 be used?

No. Bilateral adjustment is not appropriate for this anatomy, so modifier 50 should not be appended.

What documentation supports reporting 33503?

The operative report should identify the coronary artery's anomalous pulmonary origin and describe the bypass graft used to restore coronary blood flow.

How are other procedures in the same session paid?

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

What documentation is needed for an assistant or co-surgeon?

Assistant-at-surgery payment requires documentation of medical necessity. 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 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 33503PPRRVU2026_Oct_nonQPP.csv, line 3,975 (RVU26D)

Open CMS sourceHow we calculate rates

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