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Billing code 33688: VSD closureMedicare rate & RVUs

Reports surgical closure of one ventricular septal defect together with removal of a previously placed pulmonary artery band.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,742.52 for 33688 nationally in a facility.

Medicare rate · 33688

VSD closure

Swap in your local Medicare rate.

Work RVUs
33.88
Total RVUs
52.17
Global days
090

National rate · 2026

$1,742.52

Facility setting, before claim adjustments.

See every locality for 33688 → · 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 33688 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 33688 covers

This code describes an operation that closes one ventricular septal defect and removes a pulmonary artery band placed during an earlier procedure to restrict pulmonary blood flow. The surgeon may close the defect directly or use a patch, depending on its anatomy. Pediatric and congenital cardiac surgeons typically perform this repair in an operating room as part of treatment for congenital heart disease.

Report the code when the operative record supports both closure of a single VSD and removal of the band; band removal alone or closure of multiple defects is a different service. Documentation should identify the defect, closure method, and band removal. The procedure has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require 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 33688 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

33688 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,577.92
Alaska*Unavailable$2,201.26
ArizonaUnavailable$1,691.32
ArkansasUnavailable$1,558.15
AtlantaUnavailable$1,808.53
AustinUnavailable$1,731.10
BakersfieldUnavailable$1,683.60
Baltimore/Surr. CntysUnavailable$1,852.06
BeaumontUnavailable$1,692.97
BrazoriaUnavailable$1,685.82

33688 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
33688 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 33688 rate is calculated

Each of 33688’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 · 33688

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 33.88Practice expense 9.74Malpractice 8.55

52.1700 adjusted RVUs×$33.4009 conversion factor=$1,742.52

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

Payment rules and modifiers for 33688

33688 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33688

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 · 33688

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

33688 without 51 · national facility

$1,742.52

VSD closure

33688-51 · Second procedure: 50%

$871.26

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

33688 compared with similar codes

Compare codes

33688 vs 33681 vs 33677 vs 33690: national Medicare rates

Swap in your local Medicare rate.

  • 33688
    VSD closure · 33.88 wRVU
    —
  • 33681
    VSD closure · 31.53 wRVU
    —
  • 33677
    VSD repair · 37.49 wRVU
    —
  • 33690
    Pulmonary artery banding · 19.85 wRVU
    —

How to choose

33681VSD closure
Both describe closure of one VSD, but 33688 includes removal of a pulmonary artery band. Choose 33681 when that band-removal service is not part of the operation.
33677VSD repair
This code includes pulmonary artery band removal but describes closure of multiple VSDs. Code 33688 is for closure of one defect.
33690Pulmonary artery banding
33690 describes pulmonary artery banding, whereas 33688 includes removal of a previously placed band during single-VSD closure.

Codes related to 33688

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

Codes related to 33688
CodeHow it relatesNational office range
Same family
33681VSD closureSingle-VSD closure without the specified pulmonary artery band removal.No office rate
33677VSD repairMultiple-VSD counterpart that includes removal of a pulmonary artery band.No office rate
33675VSD closureClosure of multiple VSDs; distinguish by the number of defects.No office rate

33688 billing questions

How does this differ from 33681?

This code includes removal of a previously placed pulmonary artery band along with closure of one VSD. Use 33681 for single-VSD closure when the service does not include band removal.

Is pulmonary artery band removal included?

Yes. The code represents single-VSD closure with band removal; do not report the removal as a separate service when it is part of that operation.

Can this code be used for multiple VSDs?

No. It describes closure of one defect. For multiple-defect closure with band removal, compare the applicable multiple-VSD code, such as 33677.

Should modifier 50 be appended?

No. CMS identifies bilateral adjustment as inappropriate for this code; a single VSD repair is not a bilateral procedure.

What documentation supports the code and surgical assistance?

The operative report should support closure of one VSD and removal of the pulmonary artery band. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.

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 33688PPRRVU2026_Oct_nonQPP.csv, line 4,032 (RVU26D)

Open CMS sourceHow we calculate rates

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