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Billing code 33993: VAD repositioningMedicare rate & RVUs

Reports image-guided catheter repositioning of an existing percutaneous right- or left-heart ventricular assist device when its position must be adjusted to maintain support.

CMS RVU26DEffective Oct 1, 2026109 payment localities965 Medicare services in 2024

Medicare pays $142.29 for 33993 nationally in a facility.

Medicare rate · 33993

VAD repositioning

Work RVUs
3.02
Total RVUs
4.26
Global days
000

National rate · 2026

$142.29

Facility setting, before claim adjustments.

See every locality for 33993 →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 33993 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 33993 covers

This service adjusts the position of an already placed percutaneous ventricular assist device in the right or left heart, using imaging guidance to direct and confirm the repositioning. It is typically performed by an interventional cardiologist in a catheterization laboratory or another setting where temporary mechanical circulatory support is managed. The work is distinct from placing a new device or removing one that is no longer needed.

Report the code when the record supports a separate repositioning service, including the device involved, why its position required adjustment, and how imaging was used to guide the work. Imaging guidance and its associated supervision and interpretation are included. The service has 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 50% reduction. Modifier 50 is inappropriate. 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 33993 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

33993 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$131.12
Alaska*Unavailable$185.46
ArizonaUnavailable$138.81
ArkansasUnavailable$129.78
AtlantaUnavailable$146.84
AustinUnavailable$141.56
BakersfieldUnavailable$138.75
Baltimore/Surr. CntysUnavailable$150.10
BeaumontUnavailable$138.93
BrazoriaUnavailable$138.63

33993 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
33993 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 33993 rate is calculated

Each of 33993’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 · 33993

RVUs × geographic indexes × conversion factor

Work3.02

3.02 RVUs× 1.000 GPCI

Practice expense0.66

0.66 RVUs× 1.000 GPCI

Malpractice0.58

0.58 RVUs× 1.000 GPCI

Adjusted RVUs

4.2600

Conversion factor

$33.4009

Medicare rate

$142.29

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

Payment rules and modifiers for 33993

The CMS indicators that decide how 33993 is paid alongside other services.

CMS payment indicators · 33993

VAD 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)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

33993 without 51 · national facility

$142.29

VAD repositioning

33993-51 · Second procedure: 50%

$71.15

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

33993 compared with similar codes

Compare codes · National

5 codes, side by side

  • 33993

    VAD repositioning3.02 wRVU

    Not priced

  • 33990

    VAD insertion6.58 wRVU

    Not priced

  • 33991

    VAD insertion8.62 wRVU

    Not priced

  • 33995

    VAD insertion6.58 wRVU

    Not priced

  • 33992

    VAD removal3.46 wRVU

    Not priced

How to choose

33990VAD insertion
33990 reports percutaneous placement of a left-heart VAD by an arterial approach. This code is for repositioning an existing device.
33991VAD insertion
33991 reports percutaneous left-heart VAD placement using arterial and venous approaches; it is not the code for subsequent position adjustment.
33995VAD insertion
33995 reports percutaneous right-heart VAD placement. Choose this code when an existing percutaneous right- or left-heart VAD is repositioned instead.
33992VAD removal
33992 reports percutaneous removal of a left-heart VAD. Repositioning applies when the device remains in place and its position is adjusted.

Codes related to 33993

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

Codes related to 33993
CodeHow it relatesNational office range
Used instead
33990VAD insertionUse for percutaneous left-heart VAD placement by an arterial approach, rather than repositioning an existing device.No office rate
33991VAD insertionUse for percutaneous left-heart VAD placement by arterial and venous approaches, rather than repositioning.No office rate
33995VAD insertionUse for percutaneous right-heart VAD placement, rather than adjusting the position of an existing device.No office rate
33992VAD removalUse for percutaneous removal of a left-heart VAD when removal, not repositioning, is performed.No office rate
33997VAD removalUse for percutaneous removal of a right-heart VAD when removal, not repositioning, is performed.No office rate

33993 billing questions

When should this code be used instead of an insertion code?

Use it for adjusting the position of a percutaneous ventricular assist device that is already in place. Report an insertion code when the service places the device rather than repositioning it.

Is imaging guidance separately reported?

No. Imaging guidance, including the associated supervision and interpretation, is part of the repositioning service.

Can modifier 50 be used for repositioning on both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

How does the multiple-procedure reduction affect payment?

When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are paid at 50%.

Can an assistant-at-surgery be reported?

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

What documentation supports reporting repositioning?

Document the device and heart side, the reason its position needed adjustment, the repositioning performed, and the imaging used to guide the work.

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 33993PPRRVU2026_Oct_nonQPP.csv, line 4,177 (RVU26D)

Open CMS sourceHow we calculate rates

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