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Billing code 33990: VAD insertionMedicare rate & RVUs

Reports percutaneous placement of a temporary left-heart assist device through arterial access, such as for cardiogenic shock or support during high-risk PCI.

CMS RVU26DEffective Oct 1, 2026109 payment localities7.9K Medicare services in 2024

Medicare pays $312.97 for 33990 nationally in a facility.

Medicare rate · 33990

VAD insertion

Swap in your local Medicare rate.

Work RVUs
6.58
Total RVUs
9.37
Global days
000

National rate · 2026

$312.97

Facility setting, before claim adjustments.

See every locality for 33990 → · 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 33990 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 33990 covers

This service places a temporary percutaneous ventricular assist device in the left heart through arterial access, commonly the femoral artery, with the device positioned to support systemic circulation. Interventional cardiologists and cardiac surgeons perform it in a catheterization laboratory or other hospital setting, often for cardiogenic shock or hemodynamic support during high-risk percutaneous coronary intervention. Imaging supervision and interpretation for device placement are part of the service.

Report 33990 when the left-heart device is inserted using arterial access only; documentation should establish the access route, device placement, clinical indication, and imaging used to guide placement. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment may be made; 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 33990 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

33990 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$285.53
Alaska*Unavailable$402.65
ArizonaUnavailable$304.30
ArkansasUnavailable$282.25
AtlantaUnavailable$324.57
AustinUnavailable$310.02
BakersfieldUnavailable$301.20
Baltimore/Surr. CntysUnavailable$331.67
BeaumontUnavailable$305.55
BrazoriaUnavailable$303.10

33990 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
33990 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 33990 rate is calculated

Each of 33990’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 · 33990

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 6.58Practice expense 1.26Malpractice 1.53

9.3700 adjusted RVUs×$33.4009 conversion factor=$312.97

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

Payment rules and modifiers for 33990

The CMS indicators that decide how 33990 is paid alongside other services.

CMS payment indicators · 33990

VAD insertion

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)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

33990 without 51 · national facility

$312.97

VAD insertion

33990-51 · Second procedure: 50%

$156.49

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

33990 compared with similar codes

Compare codes

33990 vs 33991 vs 33995 vs 33992 vs 33988: national Medicare rates

Swap in your local Medicare rate.

  • 33990
    VAD insertion · 6.58 wRVU
    —
  • 33991
    VAD insertion · 8.62 wRVU
    —
  • 33995
    VAD insertion · 6.58 wRVU
    —
  • 33992
    VAD removal · 3.46 wRVU
    —
  • 33988
    Left heart vent · 14.63 wRVU
    —

How to choose

33991VAD insertion
33990 is for arterial access only. Choose 33991 when both arterial and venous access are used for the left-heart device insertion.
33995VAD insertion
33995 describes percutaneous right-heart assist-device insertion through venous access; 33990 is for left-heart support through arterial access.
33992VAD removal
33992 describes removal of a percutaneous left-heart assist device, not its insertion.
33988Left heart vent
33988 describes insertion of a left-heart vent by a surgical approach; 33990 is percutaneous assist-device insertion through arterial access.

Codes related to 33990

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

Codes related to 33990
CodeHow it relatesNational office range
Same family
33991VAD insertionPercutaneous left-heart device insertion using both arterial and venous access.No office rate
33992VAD removalRemoval code for a percutaneous left-heart assist device.No office rate
33993VAD repositioningRepositioning code for a percutaneous right- or left-heart assist device.No office rate
Used instead
33995VAD insertionPercutaneous assist-device insertion for right-heart support through venous access.No office rate
33988Left heart ventLeft-heart vent insertion through a different, surgical approach.No office rate

33990 billing questions

How does 33990 differ from 33991?

Use 33990 for left-heart device insertion with arterial access only. Use 33991 when insertion requires both arterial and venous access.

Is imaging reported separately?

Imaging supervision and interpretation for device placement are included in this service.

What documentation supports 33990?

Document the indication, arterial access, device placement in the left heart, and imaging used to guide the procedure.

Can an assistant surgeon be reported?

Assistant-at-surgery payment may be made for this code. Co-surgeons and team surgery are not permitted.

How does the 0-day global affect same-day care?

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

How is 33990 affected when other procedures occur in the same session?

The highest-valued procedure is paid in full, and 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 33990PPRRVU2026_Oct_nonQPP.csv, line 4,174 (RVU26D)

Open CMS sourceHow we calculate rates

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