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Billing code 33521: CABG graftingMedicare rate & RVUs

Reports the venous-graft portion of combined coronary bypass surgery when four venous grafts are placed alongside one or more arterial grafts.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.7K Medicare services in 2024

Medicare pays $593.20 for 33521 nationally in a facility.

Medicare rate · 33521

CABG grafting

Swap in your local Medicare rate.

Work RVUs
12.28
Total RVUs
17.76
Global days
ZZZ

National rate · 2026

$593.20

Facility setting, before claim adjustments.

See every locality for 33521 → · 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 33521 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 33521 covers

This add-on code represents the venous-graft portion of coronary artery bypass grafting that also uses an arterial conduit. A cardiac surgeon may use saphenous vein for the venous grafts and an internal thoracic artery or another arterial conduit for the arterial grafting. The service is performed during the same open-heart operation, typically in a hospital operating room.

Select the code by the number of venous grafts in the combined procedure: this level represents four. Report it only with the appropriate primary arterial CABG code, selected according to the arterial graft count, such as 33533–33536. The operative report should identify the arterial and venous conduits and support the number of grafts placed. Under the CMS rule, this add-on is billed only with a primary procedure and is paid within that procedure’s global period.

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 33521 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

33521 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$539.05
Alaska*Unavailable$758.16
ArizonaUnavailable$576.09
ArkansasUnavailable$532.58
AtlantaUnavailable$616.08
AustinUnavailable$587.23
BakersfieldUnavailable$569.28
Baltimore/Surr. CntysUnavailable$629.72
BeaumontUnavailable$578.65
BrazoriaUnavailable$573.48

33521 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.

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View every state and territory as a table
33521 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 33521 rate is calculated

Each of 33521’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 · 33521

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 12.28Practice expense 2.45Malpractice 3.03

17.7600 adjusted RVUs×$33.4009 conversion factor=$593.20

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

Payment rules and modifiers for 33521

The CMS indicators that decide how 33521 is paid alongside other services.

CMS payment indicators · 33521

CABG grafting

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 80 · payment effect

With and without the modifier

33521 without 80 · national facility

$593.20

CABG grafting

33521-80 · Assistant: 16%

$94.91

A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.

When to use modifier 80

33521 compared with similar codes

Compare codes

33521 vs 33513 vs 33519 vs 33522 vs 33536: national Medicare rates

Swap in your local Medicare rate.

  • 33521
    CABG grafting · 12.28 wRVU
    —
  • 33513
    Coronary bypass · 44.24 wRVU
    —
  • 33519
    CABG grafts · 10.23 wRVU
    —
  • 33522
    Coronary bypass · 13.79 wRVU
    —
  • 33536
    CABG · 47.22 wRVU
    —

How to choose

33513Coronary bypass
33513 represents four venous grafts in vein-only CABG. Use 33521 when arterial grafting is also part of the operation.
33519CABG grafts
Both codes represent combined arterial and venous CABG; 33519 is for three venous grafts, while 33521 is for four.
33522Coronary bypass
33522 is the combined-grafting level for five venous grafts. Choose 33521 when four are documented.
33536CABG
33536 identifies the arterial-graft portion when four or more arterial grafts are used; 33521 identifies the four-venous-graft portion of combined CABG.

Codes related to 33521

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

Codes related to 33521
CodeHow it relatesNational office range
Add-on codes
33533Arterial CABGPrimary arterial CABG code for one arterial graft; pair according to the documented arterial graft count.No office rate
33536CABGPrimary arterial CABG code when four or more arterial grafts are documented.No office rate
Same family
33519CABG graftsCombined arterial and venous CABG level for three venous grafts.No office rate
33522Coronary bypassCombined arterial and venous CABG level for five venous grafts.No office rate
Used instead
33513Coronary bypassFour-vein CABG level when the procedure uses venous grafting without arterial grafting.No office rate

33521 billing questions

When should 33521 be selected instead of 33513?

Use 33521 for four venous grafts in a CABG that also includes arterial grafting. Code 33513 is the four-vein level for vein-only CABG.

Which primary code is reported with 33521?

Report it with the primary arterial CABG code that reflects the number of arterial grafts, from 33533–33536. The operative report should support both graft counts.

Does 33521 represent four distal targets?

Select the level based on the number of venous grafts, not simply the number of coronary targets described. Review the operative report for the conduits and grafts placed.

Can 33521 be billed by itself?

No. CMS identifies it as an add-on code, so it must be billed with a qualifying primary procedure.

What documentation supports 33521?

The operative report should identify the venous and arterial conduits and document four venous grafts, along with the arterial grafting represented by the primary code.

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 33521PPRRVU2026_Oct_nonQPP.csv, line 3,993 (RVU26D)

Open CMS sourceHow we calculate rates

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