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Billing code 33991: VAD insertionMedicare rate & RVUs

Reports percutaneous placement of a left-heart ventricular assist device when both arterial and venous access are used for temporary circulatory support.

CMS RVU26DEffective Oct 1, 2026109 payment localities66 Medicare services in 2024

Medicare pays $415.84 for 33991 nationally in a facility.

Medicare rate · 33991

VAD insertion

Swap in your local Medicare rate.

Work RVUs
8.62
Total RVUs
12.45
Global days
000

National rate · 2026

$415.84

Facility setting, before claim adjustments.

See every locality for 33991 → · 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 33991 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 33991 covers

This service places a percutaneous ventricular assist device to support left-heart circulation, commonly for a patient with cardiogenic shock or during a high-risk cardiac intervention. A cardiologist, interventional cardiologist, or cardiac surgeon typically performs the procedure in a hospital catheterization laboratory or operating room. The distinguishing feature is use of both arterial and venous access; the related arterial-only insertion code is not interchangeable when the documented procedure requires both routes. The code includes radiological supervision and interpretation for device placement.

Report the code when the operative or catheterization report supports percutaneous left-heart device insertion and documents both access routes. The record should identify the indication, device, chamber supported, and access used. Medicare assigns 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 multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeons and team surgery are not permitted. Modifier 50 is inappropriate.

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 33991 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

33991 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$378.59
Alaska*Unavailable$532.75
ArizonaUnavailable$404.10
ArkansasUnavailable$374.13
AtlantaUnavailable$431.48
AustinUnavailable$412.00
BakersfieldUnavailable$400.08
Baltimore/Surr. CntysUnavailable$441.07
BeaumontUnavailable$405.64
BrazoriaUnavailable$402.48

33991 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
33991 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 33991 rate is calculated

Each of 33991’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 · 33991

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 8.62Practice expense 1.77Malpractice 2.06

12.4500 adjusted RVUs×$33.4009 conversion factor=$415.84

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

Payment rules and modifiers for 33991

The CMS indicators that decide how 33991 is paid alongside other services.

CMS payment indicators · 33991

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

33991 without 51 · national facility

$415.84

VAD insertion

33991-51 · Second procedure: 50%

$207.92

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

33991 compared with similar codes

Compare codes

33991 vs 33990 vs 33992 vs 33995: national Medicare rates

Swap in your local Medicare rate.

  • 33991
    VAD insertion · 8.62 wRVU
    —
  • 33990
    VAD insertion · 6.58 wRVU
    —
  • 33992
    VAD removal · 3.46 wRVU
    —
  • 33995
    VAD insertion · 6.58 wRVU
    —

How to choose

33990VAD insertion
Both codes cover percutaneous left-heart VAD insertion. Choose 33991 when arterial and venous access are used; choose 33990 for arterial access only.
33992VAD removal
33991 reports insertion of a percutaneous left-heart VAD; 33992 reports removal of that device.
33995VAD insertion
33991 is for percutaneous left-heart VAD insertion with arterial and venous access. 33995 describes percutaneous right-heart VAD insertion through venous access.

Codes related to 33991

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

Codes related to 33991
CodeHow it relatesNational office range
Used instead
33990VAD insertionPercutaneous left-heart VAD insertion when arterial access only is used.No office rate
Same family
33992VAD removalRemoval code for a percutaneously placed left-heart VAD.No office rate
33993VAD repositioningRepositioning code for a percutaneous right- or left-heart VAD.No office rate
33995VAD insertionPercutaneous VAD insertion for right-heart support using venous access.No office rate

33991 billing questions

When should 33991 be chosen instead of 33990?

Use 33991 when the percutaneous left-heart VAD insertion uses both arterial and venous access. Use 33990 when the insertion uses arterial access only.

Is imaging guidance separately reported with this code?

Radiological supervision and interpretation for device placement are included in the insertion service.

Can modifier 50 be reported?

No. Bilateral adjustment does not apply, and modifier 50 is inappropriate for this descriptor and anatomy.

How does the multiple-procedure rule affect payment?

When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction.

Can an assistant surgeon be reported?

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

What documentation distinguishes this from a later removal?

Document that a left-heart percutaneous VAD was inserted and that both arterial and venous access were used. Removal is a separate service, reported with the applicable removal code.

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 33991PPRRVU2026_Oct_nonQPP.csv, line 4,175 (RVU26D)

Open CMS sourceHow we calculate rates

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