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Billing code 33978: VAD removalMedicare rate & RVUs

Reports surgical removal of an extracorporeal ventricular assist device supporting one ventricle, such as after temporary mechanical circulatory support is no longer needed.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,236.84 for 33978 nationally in a facility.

Medicare rate · 33978

VAD removal

Swap in your local Medicare rate.

Work RVUs
24.38
Total RVUs
37.03
Global days
XXX

National rate · 2026

$1,236.84

Facility setting, before claim adjustments.

See every locality for 33978 → · 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 33978 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 33978 covers

billing code 33978 describes removal of an extracorporeal ventricular assist device that has supported a single ventricle. A cardiac surgeon may perform the procedure when a patient’s heart function has recovered enough to discontinue temporary mechanical support. The operation takes place in a surgical setting and addresses removal of the device used for ventricular support, rather than removal of an implantable intracorporeal pump or an intra-aortic balloon device.

Choose this code when the operative record identifies removal of an extracorporeal device supporting one ventricle. Documentation should establish the device type, the supported ventricle or ventricles, and that removal was performed. When other procedures occur during the same session, CMS applies the standard multiple procedure reduction: the highest-valued procedure is paid in full and the others at 50%. CMS pricing treats this service as bilateral; modifier 50 does not increase payment.

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 33978 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

33978 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,123.75
Alaska*Unavailable$1,571.19
ArizonaUnavailable$1,201.70
ArkansasUnavailable$1,110.16
AtlantaUnavailable$1,282.12
AustinUnavailable$1,229.42
BakersfieldUnavailable$1,197.87
Baltimore/Surr. CntysUnavailable$1,312.70
BeaumontUnavailable$1,202.51
BrazoriaUnavailable$1,198.39

33978 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
33978 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 33978 rate is calculated

Each of 33978’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 · 33978

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 24.38Practice expense 6.81Malpractice 5.84

37.0300 adjusted RVUs×$33.4009 conversion factor=$1,236.84

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

Payment rules and modifiers for 33978

The CMS indicators that decide how 33978 is paid alongside other services.

CMS payment indicators · 33978

VAD removal

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)2Already bilateral by definition: paid once at 100%.
Assistant at surgery (80/81/82/AS)2Paid.
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

33978 without 51 · national facility

$1,236.84

VAD removal

33978-51 · Second procedure: 50%

$618.42

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

33978 compared with similar codes

Compare codes

33978 vs 33977 vs 33980 vs 33976: national Medicare rates

Swap in your local Medicare rate.

  • 33978
    VAD removal · 24.38 wRVU
    —
  • 33977
    VAD removal · 20.34 wRVU
    —
  • 33980
    VAD removal · 32.66 wRVU
    —
  • 33976
    Ventricular assist device · 29.98 wRVU
    —

How to choose

33977VAD removal
Use 33978 for removal of an extracorporeal device supporting one ventricle; use 33977 when the device supported both ventricles.
33980VAD removal
33978 is for an extracorporeal device. 33980 is for removal of an implantable intracorporeal ventricular assist device.
33976Ventricular assist device
33976 reports insertion of an extracorporeal ventricular assist device supporting one ventricle; 33978 reports removal of that device type.

Codes related to 33978

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

Codes related to 33978
CodeHow it relatesNational office range
Same family
33977VAD removalRemoval of an extracorporeal ventricular assist device supporting both ventricles.No office rate
33976Ventricular assist deviceInsertion of an extracorporeal ventricular assist device supporting one ventricle.No office rate
33975Ventricular assist deviceInsertion of an extracorporeal ventricular assist device supporting both ventricles.No office rate
Used instead
33980VAD removalRemoval code for an implantable intracorporeal ventricular assist device.No office rate

33978 billing questions

How does 33978 differ from 33977?

33978 is for removal of an extracorporeal ventricular assist device supporting one ventricle. 33977 is the corresponding removal code for a device supporting both ventricles.

Is this the code for removing an implanted VAD?

No. 33978 covers an extracorporeal device; 33980 describes removal of an implantable intracorporeal ventricular assist device.

Should modifier 50 be added?

CMS pricing already treats 33978 as bilateral, and modifier 50 does not increase payment.

How does the multiple procedure reduction affect 33978?

When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. The reduction depends on how 33978 ranks among the procedures performed.

What documentation supports reporting 33978?

The operative report should identify the extracorporeal ventricular assist device, confirm that it supported one ventricle, and describe its removal.

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 33978PPRRVU2026_Oct_nonQPP.csv, line 4,162 (RVU26D)

Open CMS sourceHow we calculate rates

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