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Billing code 33957: ECMO cannula repositioningMedicare rate & RVUs

Reports percutaneous repositioning of peripheral cannulae in a venovenous ECMO or ECLS circuit when the cannula position needs adjustment.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $170.01 for 33957 nationally in a facility.

Medicare rate · 33957

ECMO cannula repositioning

Work RVUs
3.42
Total RVUs
5.09
Global days
000

National rate · 2026

$170.01

Facility setting, before claim adjustments.

See every locality for 33957 →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 33957 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 33957 covers

This service covers percutaneous adjustment of peripheral cannula position in a venovenous extracorporeal membrane oxygenation or extracorporeal life support circuit. It may be needed when a cannula is malpositioned or its position interferes with effective circuit flow. Cardiothoracic or vascular surgeons and other clinicians experienced in ECMO cannulation may perform the procedure in an operating room, catheterization laboratory, or intensive care setting. The service concerns repositioning an existing peripheral cannula, not placing or removing one.

Select the code when the documented procedure is percutaneous repositioning for venovenous support; the record should identify the cannula site, the reason for adjustment, and the technique performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. 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 requires documentation of medical necessity. Co-surgeons and team surgery are 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 33957 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

33957 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$154.58
Alaska*Unavailable$216.67
ArizonaUnavailable$165.19
ArkansasUnavailable$152.72
AtlantaUnavailable$176.31
AustinUnavailable$168.76
BakersfieldUnavailable$164.20
Baltimore/Surr. CntysUnavailable$180.40
BeaumontUnavailable$165.51
BrazoriaUnavailable$164.64

33957 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.

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
33957 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 33957 rate is calculated

Each of 33957’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 · 33957

RVUs × geographic indexes × conversion factor

Work3.42

3.42 RVUs× 1.000 GPCI

Practice expense0.85

0.85 RVUs× 1.000 GPCI

Malpractice0.82

0.82 RVUs× 1.000 GPCI

Adjusted RVUs

5.0900

Conversion factor

$33.4009

Medicare rate

$170.01

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

Payment rules and modifiers for 33957

The CMS indicators that decide how 33957 is paid alongside other services.

CMS payment indicators · 33957

ECMO cannula repositioning

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

33957 without 51 · national facility

$170.01

ECMO cannula repositioning

33957-51 · Second procedure: 50%

$85.01

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

33957 compared with similar codes

Compare codes · National

5 codes, side by side

  • 33957

    ECMO cannula repositioning3.42 wRVU

    Not priced

  • 33958

    Cannula repositioning3.42 wRVU

    Not priced

  • 33951

    ECMO cannulation7.95 wRVU

    Not priced

  • 33965

    ECMO cannula removal3.42 wRVU

    Not priced

  • 33948

    ECMO management4.61 wRVU

    Not priced

How to choose

33958Cannula repositioning
Both codes cover percutaneous repositioning of peripheral ECMO/ECLS cannulae; 33957 is selected for venovenous support, while 33958 represents a different circuit configuration.
33951ECMO cannulation
33951 is for peripheral cannula insertion. Use 33957 when the service adjusts the position of an existing cannula percutaneously.
33965ECMO cannula removal
33965 describes removal of a peripheral ECMO/ECLS cannula, not adjustment of its position.
33948ECMO management
33948 is for daily management of venovenous ECMO/ECLS; 33957 is for a percutaneous cannula repositioning procedure.

Codes related to 33957

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

Codes related to 33957
CodeHow it relatesNational office range
Same family
33958Cannula repositioningSibling peripheral-cannula repositioning code for a different ECMO/ECLS circuit configuration.No office rate
33959Cannula repositioningAnother peripheral-cannula repositioning variant in the ECMO/ECLS code series.No office rate
33962ECMO cannulaAnother peripheral-cannula repositioning variant in the ECMO/ECLS code series.No office rate
Used instead
33951ECMO cannulationPeripheral cannula insertion rather than repositioning an existing cannula.No office rate
33965ECMO cannula removalPeripheral ECMO/ECLS cannula removal rather than repositioning.No office rate

33957 billing questions

How is this code distinguished from 33958?

Both codes describe percutaneous repositioning of peripheral ECMO/ECLS cannulae. Choose based on the circuit configuration documented; 33957 is for venovenous support.

Can this be reported for initial cannula placement?

No. This code describes repositioning an existing peripheral cannula. Use the applicable insertion code when the service places a cannula.

Is same-day postoperative care separately reported?

Same-day preoperative and postoperative care is included in this procedure's 0-day global period.

Can modifier 50 be used?

No. CMS identifies bilateral adjustment as inappropriate for this code.

When is assistant-at-surgery payment allowed?

Only when the record documents medical necessity for the assistant. Co-surgeons and team surgery are not permitted.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full; other procedures are subject to the standard multiple procedure reduction.

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 33957PPRRVU2026_Oct_nonQPP.csv, line 4,143 (RVU26D)

Open CMS sourceHow we calculate rates

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