No office rate
33750 describes a subclavian-to-pulmonary artery shunt. Use 33606 for the pulmonary artery-to-aorta anastomosis documented in the operative report.
On this page
CMS RVU26D · Effective 2026-10-01
33606 Cardiac anastomosis Medicare reimbursement rates
Reports an operative connection between a pulmonary artery and the aorta to increase pulmonary blood flow in selected congenital heart conditions. Compare 33606 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 33606?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 33606 pays more and less
Congenital cardiac surgery
About 33606: Pulmonary artery-to-aorta anastomosis
Reports an operative connection between a pulmonary artery and the aorta to increase pulmonary blood flow in selected congenital heart conditions.
This open congenital heart operation creates a connection between a pulmonary artery and the aorta to direct systemic blood into the pulmonary circulation. It may be used as palliation for selected cyanotic congenital heart defects when pulmonary blood flow is inadequate. A congenital cardiac surgeon typically performs the procedure in a hospital operating room; the operative report should identify the vessels connected and the specific repair performed.
Report 33606 when the documented operation matches this direct arterial connection, rather than a differently configured systemic-to-pulmonary shunt or a repair of the underlying defect. The operative note should support the indication, anatomy, and work performed, and identify any other cardiac procedures done during the same session. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation. Modifier 50 is not appropriate for this anatomy, and team-surgery billing is not permitted.
CMS billing rules for 33606
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU30.74 · 61%
- Practice expense (office) RVU11.74 · 23%
- Malpractice RVU7.74 · 15%
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.
33606 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
33755 identifies a central systemic-to-pulmonary shunt. Compare its defined configuration with the direct arterial anastomosis documented for 33606.
No office rate
33762 describes another systemic-to-pulmonary shunt configuration. Select the code that matches the vessels and technique recorded by the surgeon.
See how rates vary across the country
33606 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 33606 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1516.18 |
| Alaska* | Office Unavailable | Facility $2100.18 |
| Arizona | Office Unavailable | Facility $1628.01 |
| Arkansas | Office Unavailable | Facility $1496.72 |
| Atlanta | Office Unavailable | Facility $1738.71 |
| Austin | Office Unavailable | Facility $1672.72 |
| Bakersfield | Office Unavailable | Facility $1633.46 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $1783.72 |
| Beaumont | Office Unavailable | Facility $1623.75 |
| Brazoria | Office Unavailable | Facility $1625.20 |
| Chicago | Office Unavailable | Facility $2021.33 |
| Chico | Office Unavailable | Facility $1612.54 |
| Colorado | Office Unavailable | Facility $1658.19 |
| Connecticut | Office Unavailable | Facility $1782.41 |
| Dallas | Office Unavailable | Facility $1648.36 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $1831.85 |
| Delaware | Office Unavailable | Facility $1651.71 |
| Detroit | Office Unavailable | Facility $1841.02 |
| East St. Louis | Office Unavailable | Facility $1908.17 |
| El Centro | Office Unavailable | Facility $1613.83 |
| Fort Lauderdale | Office Unavailable | Facility $1891.38 |
| Fort Worth | Office Unavailable | Facility $1647.79 |
| Fresno | Office Unavailable | Facility $1612.54 |
| Galveston | Office Unavailable | Facility $1638.40 |
| Hanford-Corcoran | Office Unavailable | Facility $1612.54 |
| Hawaii, Guam | Office Unavailable | Facility $1622.28 |
| Houston | Office Unavailable | Facility $1780.07 |
| Idaho | Office Unavailable | Facility $1509.78 |
| Indiana | Office Unavailable | Facility $1515.89 |
| Iowa | Office Unavailable | Facility $1488.17 |
| Kansas | Office Unavailable | Facility $1511.52 |
| Kentucky | Office Unavailable | Facility $1611.89 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1704.39 |
| Madera | Office Unavailable | Facility $1612.54 |
| Manhattan | Office Unavailable | Facility $1958.12 |
| Merced | Office Unavailable | Facility $1612.54 |
| Metropolitan Boston | Office Unavailable | Facility $1767.12 |
| Metropolitan Kansas City | Office Unavailable | Facility $1647.53 |
| Metropolitan Philadelphia | Office Unavailable | Facility $1761.85 |
| Metropolitan St. Louis | Office Unavailable | Facility $1659.09 |
| Miami | Office Unavailable | Facility $2088.75 |
| Minnesota | Office Unavailable | Facility $1506.76 |
| Mississippi | Office Unavailable | Facility $1555.41 |
| Modesto | Office Unavailable | Facility $1612.54 |
| Montana** | Office Unavailable | Facility $1676.88 |
| Napa | Office Unavailable | Facility $1739.58 |
| Nebraska | Office Unavailable | Facility $1486.40 |
| Nevada** | Office Unavailable | Facility $1634.61 |
| New Hampshire | Office Unavailable | Facility $1661.16 |
| New Mexico | Office Unavailable | Facility $1696.81 |
| New Orleans | Office Unavailable | Facility $1689.42 |
| North Carolina | Office Unavailable | Facility $1557.79 |
| North Dakota** | Office Unavailable | Facility $1523.83 |
| Northern Nj | Office Unavailable | Facility $1822.40 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $2038.77 |
| Ohio | Office Unavailable | Facility $1645.35 |
| Oklahoma | Office Unavailable | Facility $1577.79 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1680.05 |
| Portland | Office Unavailable | Facility $1671.17 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $1815.14 |
| Puerto Rico | Office Unavailable | Facility $1677.83 |
| Queens | Office Unavailable | Facility $1928.74 |
| Redding | Office Unavailable | Facility $1612.54 |
| Rest Of California | Office Unavailable | Facility $1612.54 |
| Rest Of Florida | Office Unavailable | Facility $1790.18 |
| Rest Of Georgia | Office Unavailable | Facility $1684.68 |
| Rest Of Illinois | Office Unavailable | Facility $1788.83 |
| Rest Of Louisiana | Office Unavailable | Facility $1621.44 |
| Rest Of Maine | Office Unavailable | Facility $1548.30 |
| Rest Of Maryland | Office Unavailable | Facility $1671.17 |
| Rest Of Massachusetts | Office Unavailable | Facility $1662.12 |
| Rest Of Michigan | Office Unavailable | Facility $1676.63 |
| Rest Of Missouri | Office Unavailable | Facility $1616.56 |
| Rest Of New Jersey | Office Unavailable | Facility $1779.62 |
| Rest Of New York | Office Unavailable | Facility $1581.01 |
| Rest Of Oregon | Office Unavailable | Facility $1599.04 |
| Rest Of Pennsylvania | Office Unavailable | Facility $1631.02 |
| Rest Of Texas | Office Unavailable | Facility $1632.32 |
| Rest Of Washington | Office Unavailable | Facility $1649.74 |
| Rhode Island | Office Unavailable | Facility $1681.92 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1695.52 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1658.32 |
| Salinas | Office Unavailable | Facility $1651.62 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1666.65 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1795.84 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1787.06 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1843.70 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1807.77 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1629.40 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1663.31 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1651.28 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1677.65 |
| Seattle (King Cnty) | Office Unavailable | Facility $1770.43 |
| South Carolina | Office Unavailable | Facility $1608.81 |
| South Dakota** | Office Unavailable | Facility $1505.73 |
| Southern Maine | Office Unavailable | Facility $1578.47 |
| Stockton | Office Unavailable | Facility $1612.54 |
| Suburban Chicago | Office Unavailable | Facility $1894.75 |
| Tennessee | Office Unavailable | Facility $1522.01 |
| Utah | Office Unavailable | Facility $1627.50 |
| Vallejo | Office Unavailable | Facility $1726.91 |
| Vermont | Office Unavailable | Facility $1545.76 |
| Virgin Islands | Office Unavailable | Facility $1677.83 |
| Virginia | Office Unavailable | Facility $1594.72 |
| Visalia | Office Unavailable | Facility $1612.54 |
| West Virginia | Office Unavailable | Facility $1737.45 |
| Wisconsin | Office Unavailable | Facility $1482.03 |
| Wyoming** | Office Unavailable | Facility $1610.18 |
| Yuba City | Office Unavailable | Facility $1612.54 |
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33606 billing questions
How is 33606 distinguished from a systemic-to-pulmonary shunt code?
Choose 33606 when the operative report supports this direct pulmonary artery-to-aorta anastomosis. Other shunt codes describe different configurations, such as a subclavian-to-pulmonary artery connection.
What documentation supports reporting 33606?
The operative report should identify the congenital condition, the pulmonary artery and aortic anatomy, and the connection created. It should also describe any additional cardiac procedures performed during the session.
Can modifier 50 be used for this service?
No. The anatomy is not reported as a paired bilateral service, so modifier 50 is inappropriate.
Can an assistant surgeon or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team-surgery billing is not permitted for this service.
How does the multiple-procedure reduction affect 33606?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction.
What care is included in the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,00733572,,Open coronary endarterectomy,A,,4.33,0.87,NA,0.87,,1.07,6.27,6.27,0,ZZZ,0.00,0.00,0.00,0,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,00833600,,Closure of valve,A,,29.55,11.68,NA,11.68,,7.44,48.67,48.67,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,00933602,,Closure of valve,A,,28.61,11.49,NA,11.49,,7.22,47.32,47.32,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,01033606,,Anastomosis/artery-aorta,A,,30.74,11.74,NA,11.74,,7.74,50.22,50.22,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,01133608,,Repair anomaly w/conduit,A,,31.08,11.98,NA,11.98,,7.84,50.90,50.90,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,01233610,,Repair by enlargement,A,,30.62,11.88,NA,11.88,,7.72,50.22,50.22,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,01333611,,Repair double ventricle,A,,34.68,10.96,NA,10.96,,8.74,54.38,54.38,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00