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Billing code 33768: Cavopulmonary anastomosisMedicare rate & RVUs

Reports the additional cavopulmonary connection of a second superior vena cava during surgical palliation for congenital heart disease with bilateral superior vena cavae.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $377.43 for 33768 nationally in a facility.

Medicare rate · 33768

Cavopulmonary anastomosis

Swap in your local Medicare rate.

Work RVUs
7.8
Total RVUs
11.30
Global days
ZZZ

National rate · 2026

$377.43

Facility setting, before claim adjustments.

See every locality for 33768 → · 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 33768 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 33768 covers

This add-on identifies the additional surgical connection of a second superior vena cava to the pulmonary artery circulation, typically when a patient has bilateral superior vena cavae and undergoes cavopulmonary palliation. Congenital cardiac surgeons perform the work in the operating room, often in children with complex congenital heart disease. The operative report should establish the bilateral venous anatomy and describe the separate connection made for the second vena cava.

Report 33768 with the primary cavopulmonary procedure, not as a stand-alone service. Select the primary code based on the extent and configuration of the main SVC-to-pulmonary-artery operation; this code identifies the additional second-SVC anastomosis. Documentation should distinguish that work from the primary connection. CMS treats this as an add-on code billed only with a primary procedure, and payment is included 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 33768 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

33768 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$342.59
Alaska*Unavailable$481.64
ArizonaUnavailable$366.41
ArkansasUnavailable$338.43
AtlantaUnavailable$392.19
AustinUnavailable$373.47
BakersfieldUnavailable$361.72
Baltimore/Surr. CntysUnavailable$400.87
BeaumontUnavailable$368.15
BrazoriaUnavailable$364.65

33768 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
33768 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 33768 rate is calculated

Each of 33768’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 · 33768

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 7.80Practice expense 1.54Malpractice 1.96

11.3000 adjusted RVUs×$33.4009 conversion factor=$377.43

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

Payment rules and modifiers for 33768

The CMS indicators that decide how 33768 is paid alongside other services.

CMS payment indicators · 33768

Cavopulmonary anastomosis

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)2Permitted.
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

33768 without 80 · national facility

$377.43

Cavopulmonary anastomosis

33768-80 · Assistant: 16%

$60.39

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

When to use modifier 80

33768 compared with similar codes

Compare codes

33768 vs 33766 vs 33767 vs 33750: national Medicare rates

Swap in your local Medicare rate.

  • 33768
    Cavopulmonary anastomosis · 7.8 wRVU
    —
  • 33766
    Glenn shunt · 22.98 wRVU
    —
  • 33767
    Cavopulmonary shunt · 24.67 wRVU
    —
  • 33750
    Systemic-to-pulmonary shunt · 21.66 wRVU
    —

How to choose

33766Glenn shunt
33766 describes the primary SVC-to-pulmonary-artery shunt involving one lung. Use 33768 to identify the additional connection for a second superior vena cava.
33767Cavopulmonary shunt
33767 describes an SVC-to-pulmonary-artery shunt involving both lungs. 33768 identifies an additional second-SVC connection, not the lung extent of the primary shunt.
33750Systemic-to-pulmonary shunt
33750 creates a shunt from the subclavian artery to the pulmonary artery. 33768 concerns a second superior vena cava in a cavopulmonary operation.

Codes related to 33768

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

Codes related to 33768
CodeHow it relatesNational office range
Primary code
33766Glenn shuntPrimary SVC-to-pulmonary-artery procedure associated with the additional second-SVC connection.No office rate
Same family
33767Cavopulmonary shuntRelated SVC-to-pulmonary-artery procedure distinguished by a connection involving both lungs.No office rate
Used instead
33750Systemic-to-pulmonary shuntCreates pulmonary blood flow from a subclavian artery rather than a superior vena cava.No office rate

33768 billing questions

Can 33768 be reported by itself?

No. It is an add-on code and must be reported with the primary procedure for the cavopulmonary operation.

What documentation supports 33768?

Document bilateral superior vena cava anatomy and the separate cavopulmonary connection created for the second vena cava.

How is 33768 different from 33766?

33766 describes the primary SVC-to-pulmonary-artery shunt involving one lung. 33768 identifies the additional connection for a second superior vena cava.

How is 33768 different from 33767?

33767 describes an SVC-to-pulmonary-artery shunt involving both lungs. 33768 identifies work for a second superior vena cava, rather than the pulmonary distribution of the primary shunt.

How is payment handled for this add-on?

CMS payment for 33768 is within the primary procedure's global period. The code is reported only with a qualifying primary procedure.

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 33768PPRRVU2026_Oct_nonQPP.csv, line 4,058 (RVU26D)

Open CMS sourceHow we calculate rates

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