No office rate
33476 describes RVOT revision, with or without enlargement, without pulmonary valve replacement. When replacement is performed with the revision, consider 33478.
On this page
CMS RVU26D · Effective 2026-10-01
33478 in Madera
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1439.61
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Cardiac surgery
About 33478: Right ventricular outflow tract revision
Reports surgical revision of the right ventricular outflow tract when reconstruction or enlargement is performed together with pulmonary valve replacement.
This code describes open surgical revision of the right ventricular outflow tract (RVOT) combined with pulmonary valve replacement. A cardiac surgeon may perform it for a patient with congenital heart disease who has a failing prior RVOT repair or conduit, pulmonary valve dysfunction, or both. A familiar clinical setting is reoperation after tetralogy of Fallot repair when the RVOT requires reconstruction and the pulmonary valve is replaced.
Report the code when the operative record supports both RVOT revision, with or without enlargement, and pulmonary valve replacement; isolated pulmonary valve replacement is distinguished from this combined service. Documentation should identify the treated outflow tract, the reconstruction performed, and the valve replacement. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. 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. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 33478
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU26.85 · 60%
- Practice expense (office) RVU11.11 · 25%
- Malpractice RVU6.75 · 15%
38
Medicare services in 2024 · #5526 by national volume
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.
33478 compared with similar codes
Office rates for Madera, from the same CMS release.
No office rate
33475 covers pulmonary valve replacement without the combined RVOT revision captured by 33478.
No office rate
33477 is a transcatheter pulmonary valve procedure. 33478 describes open surgical RVOT revision performed with pulmonary valve replacement.
The same code, a different location
How does Madera compare?
33478 across payment areas
Same release and payment basis · bars start at $0
Madera · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Merced
California · 33478
Office
Unavailable
Facility
$1439.61
No comparable office rate is available.
Modesto
California · 33478
Office
Unavailable
Facility
$1439.61
No comparable office rate is available.
Napa
California · 33478
Office
Unavailable
Facility
$1556.93
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 33478
Office
Unavailable
Facility
$1501.01
No comparable office rate is available.
Redding
California · 33478
Office
Unavailable
Facility
$1439.61
No comparable office rate is available.
Rest Of California
California · 33478
Office
Unavailable
Facility
$1439.61
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 33478
Office
Unavailable
Facility
$1511.98
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 33478
Office
Unavailable
Facility
$1481.51
No comparable office rate is available.
Salinas
California · 33478
Office
Unavailable
Facility
$1475.55
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 33478
Office
Unavailable
Facility
$1489.73
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 33478
Office
Unavailable
Facility
$1608.72
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 33478
Office
Unavailable
Facility
$1601.06
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 33478
Office
Unavailable
Facility
$1651.41
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 33478
Office
Unavailable
Facility
$1620.07
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 33478
Office
Unavailable
Facility
$1455.57
No comparable office rate is available.
Santa Cruz-Watsonville
California · 33478
Office
Unavailable
Facility
$1487.36
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 33478
Office
Unavailable
Facility
$1475.45
No comparable office rate is available.
Santa Rosa-Petaluma
California · 33478
Office
Unavailable
Facility
$1500.25
No comparable office rate is available.
Stockton
California · 33478
Office
Unavailable
Facility
$1439.61
No comparable office rate is available.
Vallejo
California · 33478
Office
Unavailable
Facility
$1545.89
No comparable office rate is available.
Visalia
California · 33478
Office
Unavailable
Facility
$1439.61
No comparable office rate is available.
Yuba City
California · 33478
Office
Unavailable
Facility
$1439.61
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 33478
Office
Unavailable
Facility
$1633.31
No comparable office rate is available.
Miami
Florida · 33478
Office
Unavailable
Facility
$1853.29
No comparable office rate is available.
Chicago
Illinois · 33478
Office
Unavailable
Facility
$1793.45
No comparable office rate is available.
Manhattan
New York · 33478
Office
Unavailable
Facility
$1742.98
No comparable office rate is available.
Alaska*
Alaska · 33478
Office
Unavailable
Facility
$1864.65
No comparable office rate is available.
Alabama
Alabama · 33478
Office
Unavailable
Facility
$1349.12
No comparable office rate is available.
Arkansas
Arkansas · 33478
Office
Unavailable
Facility
$1331.69
No comparable office rate is available.
Arizona
Arizona · 33478
Office
Unavailable
Facility
$1449.38
No comparable office rate is available.
Colorado
Colorado · 33478
Office
Unavailable
Facility
$1478.49
No comparable office rate is available.
Connecticut
Connecticut · 33478
Office
Unavailable
Facility
$1587.21
No comparable office rate is available.
Delaware
Delaware · 33478
Office
Unavailable
Facility
$1470.61
No comparable office rate is available.
Fort Lauderdale
Florida · 33478
Office
Unavailable
Facility
$1680.35
No comparable office rate is available.
Rest Of Florida
Florida · 33478
Office
Unavailable
Facility
$1590.43
No comparable office rate is available.
Atlanta
Georgia · 33478
Office
Unavailable
Facility
$1547.30
No comparable office rate is available.
Rest Of Georgia
Georgia · 33478
Office
Unavailable
Facility
$1496.56
No comparable office rate is available.
Hawaii, Guam
Hawaii · 33478
Office
Unavailable
Facility
$1449.28
No comparable office rate is available.
Iowa
Iowa · 33478
Office
Unavailable
Facility
$1325.86
No comparable office rate is available.
Idaho
Idaho · 33478
Office
Unavailable
Facility
$1344.85
No comparable office rate is available.
East St. Louis
Illinois · 33478
Office
Unavailable
Facility
$1692.28
No comparable office rate is available.
Rest Of Illinois
Illinois · 33478
Office
Unavailable
Facility
$1588.00
No comparable office rate is available.
Suburban Chicago
Illinois · 33478
Office
Unavailable
Facility
$1683.70
No comparable office rate is available.
Indiana
Indiana · 33478
Office
Unavailable
Facility
$1350.38
No comparable office rate is available.
Kansas
Kansas · 33478
Office
Unavailable
Facility
$1345.90
No comparable office rate is available.
Kentucky
Kentucky · 33478
Office
Unavailable
Facility
$1433.00
No comparable office rate is available.
New Orleans
Louisiana · 33478
Office
Unavailable
Facility
$1502.12
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 33478
Office
Unavailable
Facility
$1441.21
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 33478
Office
Unavailable
Facility
$1577.31
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 33478
Office
Unavailable
Facility
$1481.60
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 33478
Office
Unavailable
Facility
$1588.23
No comparable office rate is available.
Rest Of Maryland
Maryland · 33478
Office
Unavailable
Facility
$1488.29
No comparable office rate is available.
Rest Of Maine
Maine · 33478
Office
Unavailable
Facility
$1378.45
No comparable office rate is available.
Southern Maine
Maine · 33478
Office
Unavailable
Facility
$1406.82
No comparable office rate is available.
Detroit
Michigan · 33478
Office
Unavailable
Facility
$1635.03
No comparable office rate is available.
Rest Of Michigan
Michigan · 33478
Office
Unavailable
Facility
$1490.15
No comparable office rate is available.
Minnesota
Minnesota · 33478
Office
Unavailable
Facility
$1345.39
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 33478
Office
Unavailable
Facility
$1465.53
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 33478
Office
Unavailable
Facility
$1475.99
No comparable office rate is available.
Rest Of Missouri
Missouri · 33478
Office
Unavailable
Facility
$1436.28
No comparable office rate is available.
Mississippi
Mississippi · 33478
Office
Unavailable
Facility
$1382.93
No comparable office rate is available.
Montana**
Montana · 33478
Office
Unavailable
Facility
$1492.90
No comparable office rate is available.
North Carolina
North Carolina · 33478
Office
Unavailable
Facility
$1387.10
No comparable office rate is available.
North Dakota**
North Dakota · 33478
Office
Unavailable
Facility
$1359.43
No comparable office rate is available.
Nebraska
Nebraska · 33478
Office
Unavailable
Facility
$1324.55
No comparable office rate is available.
New Hampshire
New Hampshire · 33478
Office
Unavailable
Facility
$1480.39
No comparable office rate is available.
Northern Nj
New Jersey · 33478
Office
Unavailable
Facility
$1624.56
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 33478
Office
Unavailable
Facility
$1585.24
No comparable office rate is available.
New Mexico
New Mexico · 33478
Office
Unavailable
Facility
$1507.87
No comparable office rate is available.
Nevada**
Nevada · 33478
Office
Unavailable
Facility
$1456.07
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 33478
Office
Unavailable
Facility
$1814.10
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 33478
Office
Unavailable
Facility
$1616.31
No comparable office rate is available.
Queens
New York · 33478
Office
Unavailable
Facility
$1717.94
No comparable office rate is available.
Rest Of New York
New York · 33478
Office
Unavailable
Facility
$1407.84
No comparable office rate is available.
Ohio
Ohio · 33478
Office
Unavailable
Facility
$1462.87
No comparable office rate is available.
Oklahoma
Oklahoma · 33478
Office
Unavailable
Facility
$1403.37
No comparable office rate is available.
Portland
Oregon · 33478
Office
Unavailable
Facility
$1491.18
No comparable office rate is available.
Rest Of Oregon
Oregon · 33478
Office
Unavailable
Facility
$1424.91
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 33478
Office
Unavailable
Facility
$1568.22
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 33478
Office
Unavailable
Facility
$1450.53
No comparable office rate is available.
Puerto Rico
Puerto Rico · 33478
Office
Unavailable
Facility
$1494.05
No comparable office rate is available.
Rhode Island
Rhode Island · 33478
Office
Unavailable
Facility
$1498.29
No comparable office rate is available.
South Carolina
South Carolina · 33478
Office
Unavailable
Facility
$1431.33
No comparable office rate is available.
South Dakota**
South Dakota · 33478
Office
Unavailable
Facility
$1343.65
No comparable office rate is available.
Tennessee
Tennessee · 33478
Office
Unavailable
Facility
$1355.20
No comparable office rate is available.
Austin
Texas · 33478
Office
Unavailable
Facility
$1490.97
No comparable office rate is available.
Beaumont
Texas · 33478
Office
Unavailable
Facility
$1443.95
No comparable office rate is available.
Brazoria
Texas · 33478
Office
Unavailable
Facility
$1447.59
No comparable office rate is available.
Dallas
Texas · 33478
Office
Unavailable
Facility
$1467.93
No comparable office rate is available.
Fort Worth
Texas · 33478
Office
Unavailable
Facility
$1467.15
No comparable office rate is available.
Galveston
Texas · 33478
Office
Unavailable
Facility
$1459.15
No comparable office rate is available.
Houston
Texas · 33478
Office
Unavailable
Facility
$1582.70
No comparable office rate is available.
Rest Of Texas
Texas · 33478
Office
Unavailable
Facility
$1452.56
No comparable office rate is available.
Utah
Utah · 33478
Office
Unavailable
Facility
$1448.09
No comparable office rate is available.
Virginia
Virginia · 33478
Office
Unavailable
Facility
$1420.76
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 33478
Office
Unavailable
Facility
$1494.05
No comparable office rate is available.
Vermont
Vermont · 33478
Office
Unavailable
Facility
$1378.27
No comparable office rate is available.
Rest Of Washington
Washington · 33478
Office
Unavailable
Facility
$1470.80
No comparable office rate is available.
Seattle (King Cnty)
Washington · 33478
Office
Unavailable
Facility
$1581.17
No comparable office rate is available.
Wisconsin
Wisconsin · 33478
Office
Unavailable
Facility
$1321.75
No comparable office rate is available.
West Virginia
West Virginia · 33478
Office
Unavailable
Facility
$1541.91
No comparable office rate is available.
Wyoming**
Wyoming · 33478
Office
Unavailable
Facility
$1434.74
No comparable office rate is available.
See how rates vary across the country
33478 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Madera is a Medicare payment area. Our Census mapping connects it to 17 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 33478 in Madera. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1583.57
$1439.61 × 110% = $1583.57
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 33478 in Madera.
PPRRVU2026_Oct_nonQPP.csv
3,970
- Code
- 33478
- Physician work
- 26.85
- Practice expense
- 11.11
- Malpractice
- 6.75
GPCI2026.csv
14
- Locality
- Madera
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 26.85 | × 1.017 | 27.3064 |
| Practice expense | 11.11 | × 1.096 | 12.1766 |
| Malpractice | 6.75 | × 0.536 | 3.6180 |
| Total RVUs | 43.1010 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Madera$1439.61
Open 33478 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 26.85 | 1.017 |
| Practice expense | 11.11 | 1.096 |
| Malpractice | 6.75 | 0.536 |
(26.85 × 1.017 + 11.11 × 1.096 + 6.75 × 0.536) × $33.4009 = $1439.61
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
33478 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1439.61 | RVU26D |
| 2026-07-01 | Not available in this setting | $1439.61 | RVU26C |
| 2026-04-01 | Not available in this setting | $1439.61 | RVU26B |
| 2026-01-01 | Not available in this setting | $1439.61 | RVU26A |
| 2025-10-01 | Not available in this setting | $1465.90 | RVU25D |
| 2025-07-01 | Not available in this setting | $1465.90 | RVU25C |
| 2025-04-01 | Not available in this setting | $1465.90 | RVU25B |
| 2025-01-01 | Not available in this setting | $1465.90 | RVU25A |
33478 billing questions
Can 33475 also be reported for the valve replacement?
The pulmonary valve replacement is part of the combined service described by 33478. Do not separately report 33475 for that same replacement.
When is 33476 a better fit?
Use 33476 for RVOT revision with or without enlargement when pulmonary valve replacement is not performed. The presence of pulmonary valve replacement distinguishes 33478.
What documentation supports 33478?
The operative report should describe the RVOT revision or enlargement and the pulmonary valve replacement. A record describing only valve replacement does not support the combined service.
Can modifier 50 be used for work on both sides?
No. Modifier 50 is inappropriate for this code; CMS does not apply a bilateral adjustment.
How are other procedures in the same session paid?
Under the CMS multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,96733475,,Replacement pulmonary valve,A,,41.34,13.19,NA,13.19,,9.80,64.33,64.33,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96833476,,Revision of heart chamber,A,,25.91,10.93,NA,10.93,,6.53,43.37,43.37,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96933477,,Implant tcat pulm vlv perq,A,,24.38,5.11,NA,5.11,,4.23,33.72,33.72,0,000,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97033478,,Revision of heart chamber,A,,26.85,11.11,NA,11.11,,6.75,44.71,44.71,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97133496,,Repair prosth valve clot,A,,29.09,11.43,NA,11.43,,6.98,47.50,47.50,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97233500,,Repair heart vessel fistula,A,,27.24,10.78,NA,10.78,,6.53,44.55,44.55,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97333501,,Repair heart vessel fistula,A,,19.02,8.62,NA,8.62,,4.55,32.19,32.19,0,090,0.09,0.84,0.07,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1101112,CA,56,FRESNO,1.017,1.096,0.536
1201112,CA,57,HANFORD-CORCORAN,1.017,1.096,0.536
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508