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Billing code 33997: VAD removalMedicare rate & RVUs

Removal of a percutaneously placed right-heart ventricular assist device, typically after temporary mechanical support for acute right ventricular failure is no longer needed.

CMS RVU26DEffective Oct 1, 2026109 payment localities127 Medicare services in 2024

Medicare pays $139.62 for 33997 nationally in a facility.

Medicare rate · 33997

VAD removal

Swap in your local Medicare rate.

Work RVUs
2.93
Total RVUs
4.18
Global days
000

National rate · 2026

$139.62

Facility setting, before claim adjustments.

See every locality for 33997 → · 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 33997 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 33997 covers

This service removes a temporary ventricular assist device that provides percutaneous support to the right side of the heart, generally through venous access. It is typically performed by a cardiac surgeon or interventional cardiologist in a hospital setting, such as a cardiac catheterization laboratory or intensive care unit, when the patient has recovered enough to stop mechanical support or the device must be removed for another clinical reason.

Report the removal rather than device insertion or repositioning, and document the device, its percutaneous right-heart configuration, the removal, and the reason support is ending. The CMS global period is 0 days, 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. Modifier 50 is inappropriate for this single right-heart device service. 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 33997 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

33997 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$127.48
Alaska*Unavailable$179.76
ArizonaUnavailable$135.79
ArkansasUnavailable$126.03
AtlantaUnavailable$144.72
AustinUnavailable$138.38
BakersfieldUnavailable$134.58
Baltimore/Surr. CntysUnavailable$147.90
BeaumontUnavailable$136.28
BrazoriaUnavailable$135.30

33997 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
33997 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 33997 rate is calculated

Each of 33997’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 · 33997

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 2.93Practice expense 0.58Malpractice 0.67

4.1800 adjusted RVUs×$33.4009 conversion factor=$139.62

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

Payment rules and modifiers for 33997

The CMS indicators that decide how 33997 is paid alongside other services.

CMS payment indicators · 33997

VAD removal

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

33997 without 51 · national facility

$139.62

VAD removal

33997-51 · Second procedure: 50%

$69.81

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

33997 compared with similar codes

Compare codes

33997 vs 33992 vs 33993 vs 33995 vs 33980: national Medicare rates

Swap in your local Medicare rate.

  • 33997
    VAD removal · 2.93 wRVU
    —
  • 33992
    VAD removal · 3.46 wRVU
    —
  • 33993
    VAD repositioning · 3.02 wRVU
    —
  • 33995
    VAD insertion · 6.58 wRVU
    —
  • 33980
    VAD removal · 32.66 wRVU
    —

How to choose

33992VAD removal
Choose 33997 for percutaneous right-heart VAD removal; 33992 is for percutaneous left-heart VAD removal.
33993VAD repositioning
33993 represents repositioning a percutaneous right- or left-heart VAD. Report 33997 when the right-heart device is removed.
33995VAD insertion
33995 is for placing percutaneous right-heart VAD support; 33997 is for taking that type of device out.
33980VAD removal
33980 concerns removal of an intracorporeal VAD. Use 33997 for removal of a percutaneous right-heart device.

Codes related to 33997

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

Codes related to 33997
CodeHow it relatesNational office range
Same family
33992VAD removalRemoval counterpart for a percutaneous left-heart VAD.No office rate
33993VAD repositioningRepositioning code for a percutaneous right- or left-heart VAD.No office rate
33995VAD insertionInsertion code for percutaneous right-heart VAD support.No office rate
Used instead
33977VAD removalRemoval code for a different ventricular-device configuration.No office rate
33978VAD removalRemoval code for a different ventricular-device configuration.No office rate
33980VAD removalRemoval code for an intracorporeal ventricular assist device.No office rate

33997 billing questions

How is this different from 33992?

33997 is for removal of a percutaneous right-heart VAD. Code 33992 is the corresponding removal code for a percutaneous left-heart VAD.

Should removal be reported with repositioning?

Use 33997 when the device is removed. Code 33993 describes repositioning a percutaneous right- or left-heart VAD, not removal.

What documentation supports 33997?

Document the percutaneous right-heart device, its removal, and the clinical reason it was taken out. The record should distinguish removal from repositioning or removal of a different VAD configuration.

Can an assistant surgeon be reported?

CMS permits assistant-at-surgery payment for this code. Co-surgeons and team surgery are not permitted.

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

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

Is modifier 50 appropriate?

No. The service concerns a single right-heart device, so the descriptor and anatomy make modifier 50 inappropriate.

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 33997PPRRVU2026_Oct_nonQPP.csv, line 4,179 (RVU26D)

Open CMS sourceHow we calculate rates

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