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Billing code 33684: VSD closureMedicare rate & RVUs

Reports surgical closure of one ventricular septal defect together with pulmonary valve incision to relieve obstruction during congenital heart repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,760.23 for 33684 nationally in a facility.

Medicare rate · 33684

VSD closure

Work RVUs
33.51
Total RVUs
52.70
Global days
090

National rate · 2026

$1,760.23

Facility setting, before claim adjustments.

See every locality for 33684 →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 33684 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 33684 covers

This code describes open repair of a single ventricular septal defect (VSD) performed with pulmonary valvotomy. The surgeon closes the opening between the ventricles, using direct sutures or a patch as the anatomy requires, and incises the pulmonary valve to improve its opening. It is used for congenital cardiac operations in which both services are part of the same repair, commonly performed by a congenital cardiac surgeon in a hospital operating room.

Report the code when the operative documentation supports closure of one VSD and the accompanying pulmonary valvotomy. The record should identify the defect and describe the valve work; whether the septal closure uses a patch does not change the code selection. Medicare assigns a 90-day global period, including 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 other procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery payment may be made; 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 33684 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

33684 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,592.79
Alaska*Unavailable$2,216.28
ArizonaUnavailable$1,708.43
ArkansasUnavailable$1,572.65
AtlantaUnavailable$1,826.12
AustinUnavailable$1,751.04
BakersfieldUnavailable$1,705.41
Baltimore/Surr. CntysUnavailable$1,871.27
BeaumontUnavailable$1,707.91
BrazoriaUnavailable$1,703.79

33684 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
33684 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 33684 rate is calculated

Each of 33684’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 · 33684

RVUs × geographic indexes × conversion factor

Work33.51

33.51 RVUs× 1.000 GPCI

Practice expense10.73

10.73 RVUs× 1.000 GPCI

Malpractice8.46

8.46 RVUs× 1.000 GPCI

Adjusted RVUs

52.7000

Conversion factor

$33.4009

Medicare rate

$1,760.23

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

Payment rules and modifiers for 33684

33684 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33684

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 · 33684

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.

  • 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

33684 without 51 · national facility

$1,760.23

VSD closure

33684-51 · Second procedure: 50%

$880.12

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

33684 compared with similar codes

Compare codes · National

4 codes, side by side

  • 33684

    VSD closure33.51 wRVU

    Not priced

  • 33681

    VSD closure31.53 wRVU

    Not priced

  • 33675

    VSD closure35.05 wRVU

    Not priced

  • 33688

    VSD closure33.88 wRVU

    Not priced

How to choose

33681VSD closure
Both describe closure of one VSD, with or without a patch. Choose 33684 when pulmonary valvotomy is also performed as part of the repair.
33675VSD closure
33675 is for closure of multiple VSDs. This code is for a single VSD and includes pulmonary valvotomy.
33688VSD closure
33688 describes single-VSD closure with removal of a pulmonary artery band. This code is distinguished by pulmonary valvotomy.

Codes related to 33684

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

Codes related to 33684
CodeHow it relatesNational office range
Same family
33681VSD closureSingle-VSD closure without the pulmonary valvotomy distinction.No office rate
33675VSD closureClosure of multiple VSDs rather than one.No office rate
33676VSD repairMultiple-VSD closure that also includes resection.No office rate
33677VSD repairMultiple-VSD closure with removal of a pulmonary artery band.No office rate
33688VSD closureSingle-VSD closure with removal of a pulmonary artery band.No office rate

33684 billing questions

How does this differ from 33681?

33684 includes pulmonary valvotomy with closure of one VSD. Use 33681 for the single-VSD closure when pulmonary valvotomy is not part of the repair.

Does the code require a patch?

No. The VSD may be closed with direct sutures or a patch; the defining distinction is the accompanying pulmonary valvotomy.

Can this code be used for multiple VSDs?

No. This code describes closure of one VSD. Codes such as 33675 and 33676 address multiple-defect repairs, with 33676 also specifying resection.

What documentation supports reporting 33684?

The operative report should establish that one VSD was closed and that pulmonary valvotomy was performed during the repair. It should describe the closure method and the valve work.

How is same-session surgery paid under Medicare?

When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and applies the standard multiple procedure reduction to the others. The 90-day global period includes the day-before preoperative visit and related postoperative care.

May an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, and 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 33684PPRRVU2026_Oct_nonQPP.csv, line 4,031 (RVU26D)

Open CMS sourceHow we calculate rates

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