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Billing code 33681: VSD closureMedicare rate & RVUs

Open cardiac surgery to close one ventricular septal defect, using direct closure or a patch, when no separately specified added maneuver changes code selection.

CMS RVU26DEffective Oct 1, 2026109 payment localities180 Medicare services in 2024

Medicare pays $1,745.87 for 33681 nationally in a facility.

Medicare rate · 33681

VSD closure

Swap in your local Medicare rate.

Work RVUs
31.53
Total RVUs
52.27
Global days
090

National rate · 2026

$1,745.87

Facility setting, before claim adjustments.

See every locality for 33681 → · 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 33681 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 33681 covers

A congenital cardiac surgeon uses this code for operative closure of a single opening between the heart’s ventricles. The surgeon may close the defect directly or use a patch; the code covers either method. This is typically an operating-room procedure for a patient with a ventricular septal defect requiring surgical repair, rather than catheter-based device closure. The operative report should establish that one defect was closed and describe the repair performed.

Select this code by the number of defects repaired and the operative work: closure of multiple defects, or closure combined with a specifically described maneuver such as pulmonary valvotomy or removal of a pulmonary artery band, may point to a different code. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others 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 33681 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

33681 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,577.22
Alaska*Unavailable$2,180.97
ArizonaUnavailable$1,694.38
ArkansasUnavailable$1,556.84
AtlantaUnavailable$1,809.23
AustinUnavailable$1,742.48
BakersfieldUnavailable$1,703.06
Baltimore/Surr. CntysUnavailable$1,856.83
BeaumontUnavailable$1,688.56
BrazoriaUnavailable$1,692.03

33681 rates by state

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

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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 every state and territory as a table
33681 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 33681 rate is calculated

Each of 33681’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 · 33681

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 31.53Practice expense 12.79Malpractice 7.95

52.2700 adjusted RVUs×$33.4009 conversion factor=$1,745.87

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

Payment rules and modifiers for 33681

33681 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33681

VSD closure

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 · 33681

VSD closure

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

33681 without 51 · national facility

$1,745.87

VSD closure

33681-51 · Second procedure: 50%

$872.94

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

33681 compared with similar codes

Compare codes

33681 vs 33675 vs 33684 vs 33688 vs 33641: national Medicare rates

Swap in your local Medicare rate.

  • 33681
    VSD closure · 31.53 wRVU
    —
  • 33675
    VSD closure · 35.05 wRVU
    —
  • 33684
    VSD closure · 33.51 wRVU
    —
  • 33688
    VSD closure · 33.88 wRVU
    —
  • 33641
    ASD repair · 28.84 wRVU
    —

How to choose

33675VSD closure
33681 is for closing one ventricular septal defect. Use 33675 for closure of multiple defects when its descriptor fits the operative work.
33684VSD closure
33684 describes single-defect closure combined with pulmonary valvotomy or infundibular resection; 33681 covers closure without that specified added work.
33688VSD closure
Choose 33688 when single-defect closure is performed with removal of a pulmonary artery band; 33681 does not capture that combination.
33641ASD repair
33641 concerns repair of an atrial septal defect. Use 33681 for a ventricular septal defect.

Codes related to 33681

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

Codes related to 33681
CodeHow it relatesNational office range
Same family
33675VSD closureClosure of multiple ventricular septal defects rather than one.No office rate
33676VSD repairMultiple-defect closure with additional resection work.No office rate
33677VSD repairMultiple-defect closure combined with pulmonary artery band removal.No office rate
33684VSD closureSingle-defect closure with pulmonary valvotomy or infundibular resection.No office rate
33688VSD closureSingle-defect closure combined with removal of a pulmonary artery band.No office rate
Used instead
33641ASD repairRepair of an atrial septal defect, not a ventricular septal defect.No office rate

33681 billing questions

When is 33681 selected instead of a multiple-defect closure code?

Use 33681 when the operation closes one ventricular septal defect. Closure of multiple defects is represented by a different code, with the exact choice depending on additional operative work.

Does using a patch change the code?

No. This code covers closure of one defect whether the surgeon closes it directly or uses a patch.

How should a closure with pulmonary valvotomy be coded?

Check the code for single-defect closure that includes pulmonary valvotomy or infundibular resection, 33684, rather than defaulting to 33681.

Is removal of a pulmonary artery band included in 33681?

A closure performed with removal of a pulmonary artery band is described by 33688. The operative report should document whether that band-removal work was performed.

What documentation supports 33681?

Document that one ventricular septal defect was repaired and describe whether the closure was direct or used a patch. Record any additional cardiac procedure or maneuver that could change code selection.

How does the global period affect postoperative billing?

The 90-day global period includes the day-before preoperative visit and 90 days of 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 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 33681PPRRVU2026_Oct_nonQPP.csv, line 4,030 (RVU26D)

Open CMS sourceHow we calculate rates

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