No office rate
33990 describes insertion of a percutaneous left-heart VAD through arterial access; 33992 describes its removal.
On this page
CMS RVU26D · Effective 2026-10-01
33992 in Wyoming**
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$157.88
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 33992: Percutaneous left-heart VAD removal
Removal of a percutaneously placed left-heart ventricular assist device is reported when temporary mechanical circulatory support is discontinued.
This service covers withdrawing a catheter-based ventricular assist device used to support the left heart. It is commonly performed by an interventional cardiologist or cardiac surgeon in a catheterization laboratory or other procedural setting when the patient’s hemodynamic condition allows temporary support to end. The code identifies removal of the percutaneous left-heart device, rather than implantation, repositioning, or removal of a right-heart device.
Report the code when the documented service removes that percutaneous left-heart VAD; the record should identify the device and support the removal performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this descriptor. Assistant-at-surgery services may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 33992
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.46 · 70%
- Practice expense (office) RVU0.66 · 13%
- Malpractice RVU0.82 · 17%
2.7K
Medicare services in 2024 · #2256 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.
33992 compared with similar codes
Office rates for Wyoming**, from the same CMS release.
No office rate
33991 describes percutaneous left-heart VAD insertion using arterial and venous access. It is not the removal service represented by 33992.
No office rate
33997 is for removal of a percutaneous right-heart VAD; 33992 is for a percutaneous left-heart VAD.
No office rate
33989 describes removal of a left-heart vent. Select 33992 when the removed device is a percutaneous left-heart VAD.
The same code, a different location
How does Wyoming** compare?
33992 across payment areas
Same release and payment basis · bars start at $0
Wyoming** · This locality
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.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Wyoming 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
Alabama
Alabama · 33992
Office
Unavailable
Facility
$150.36
No comparable office rate is available.
Arkansas
Arkansas · 33992
Office
Unavailable
Facility
$148.61
No comparable office rate is available.
Arizona
Arizona · 33992
Office
Unavailable
Facility
$160.37
No comparable office rate is available.
Bakersfield
California · 33992
Office
Unavailable
Facility
$158.60
No comparable office rate is available.
Chico
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
El Centro
California · 33992
Office
Unavailable
Facility
$156.51
No comparable office rate is available.
Fresno
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
Hanford-Corcoran
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
Madera
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
Merced
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
Modesto
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
Napa
California · 33992
Office
Unavailable
Facility
$165.82
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 33992
Office
Unavailable
Facility
$161.92
No comparable office rate is available.
Redding
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
Rest Of California
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 33992
Office
Unavailable
Facility
$165.17
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 33992
Office
Unavailable
Facility
$160.05
No comparable office rate is available.
Salinas
California · 33992
Office
Unavailable
Facility
$159.38
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 33992
Office
Unavailable
Facility
$160.24
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 33992
Office
Unavailable
Facility
$170.20
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 33992
Office
Unavailable
Facility
$169.27
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 33992
Office
Unavailable
Facility
$174.75
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 33992
Office
Unavailable
Facility
$170.94
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 33992
Office
Unavailable
Facility
$157.32
No comparable office rate is available.
Santa Cruz-Watsonville
California · 33992
Office
Unavailable
Facility
$159.46
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 33992
Office
Unavailable
Facility
$159.19
No comparable office rate is available.
Santa Rosa-Petaluma
California · 33992
Office
Unavailable
Facility
$160.79
No comparable office rate is available.
Stockton
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
Vallejo
California · 33992
Office
Unavailable
Facility
$164.47
No comparable office rate is available.
Visalia
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
Yuba City
California · 33992
Office
Unavailable
Facility
$156.37
No comparable office rate is available.
Colorado
Colorado · 33992
Office
Unavailable
Facility
$161.80
No comparable office rate is available.
Connecticut
Connecticut · 33992
Office
Unavailable
Facility
$174.76
No comparable office rate is available.
Delaware
Delaware · 33992
Office
Unavailable
Facility
$162.55
No comparable office rate is available.
Fort Lauderdale
Florida · 33992
Office
Unavailable
Facility
$187.42
No comparable office rate is available.
Rest Of Florida
Florida · 33992
Office
Unavailable
Facility
$177.81
No comparable office rate is available.
Atlanta
Georgia · 33992
Office
Unavailable
Facility
$171.20
No comparable office rate is available.
Rest Of Georgia
Georgia · 33992
Office
Unavailable
Facility
$167.88
No comparable office rate is available.
Hawaii, Guam
Hawaii · 33992
Office
Unavailable
Facility
$156.49
No comparable office rate is available.
Iowa
Iowa · 33992
Office
Unavailable
Facility
$146.61
No comparable office rate is available.
Idaho
Idaho · 33992
Office
Unavailable
Facility
$148.80
No comparable office rate is available.
East St. Louis
Illinois · 33992
Office
Unavailable
Facility
$191.01
No comparable office rate is available.
Rest Of Illinois
Illinois · 33992
Office
Unavailable
Facility
$178.50
No comparable office rate is available.
Suburban Chicago
Illinois · 33992
Office
Unavailable
Facility
$187.55
No comparable office rate is available.
Indiana
Indiana · 33992
Office
Unavailable
Facility
$149.31
No comparable office rate is available.
Kansas
Kansas · 33992
Office
Unavailable
Facility
$149.30
No comparable office rate is available.
Kentucky
Kentucky · 33992
Office
Unavailable
Facility
$160.23
No comparable office rate is available.
New Orleans
Louisiana · 33992
Office
Unavailable
Facility
$167.42
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 33992
Office
Unavailable
Facility
$161.31
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 33992
Office
Unavailable
Facility
$171.00
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 33992
Office
Unavailable
Facility
$162.46
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 33992
Office
Unavailable
Facility
$174.95
No comparable office rate is available.
Rest Of Maryland
Maryland · 33992
Office
Unavailable
Facility
$164.17
No comparable office rate is available.
Rest Of Maine
Maine · 33992
Office
Unavailable
Facility
$152.88
No comparable office rate is available.
Southern Maine
Maine · 33992
Office
Unavailable
Facility
$154.70
No comparable office rate is available.
Detroit
Michigan · 33992
Office
Unavailable
Facility
$183.02
No comparable office rate is available.
Rest Of Michigan
Michigan · 33992
Office
Unavailable
Facility
$166.62
No comparable office rate is available.
Minnesota
Minnesota · 33992
Office
Unavailable
Facility
$146.36
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 33992
Office
Unavailable
Facility
$163.03
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 33992
Office
Unavailable
Facility
$164.00
No comparable office rate is available.
Rest Of Missouri
Missouri · 33992
Office
Unavailable
Facility
$161.25
No comparable office rate is available.
Mississippi
Mississippi · 33992
Office
Unavailable
Facility
$154.79
No comparable office rate is available.
Montana**
Montana · 33992
Office
Unavailable
Facility
$164.95
No comparable office rate is available.
North Carolina
North Carolina · 33992
Office
Unavailable
Facility
$153.64
No comparable office rate is available.
North Dakota**
North Dakota · 33992
Office
Unavailable
Facility
$148.73
No comparable office rate is available.
Nebraska
Nebraska · 33992
Office
Unavailable
Facility
$146.27
No comparable office rate is available.
New Hampshire
New Hampshire · 33992
Office
Unavailable
Facility
$162.48
No comparable office rate is available.
Northern Nj
New Jersey · 33992
Office
Unavailable
Facility
$177.67
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 33992
Office
Unavailable
Facility
$174.31
No comparable office rate is available.
New Mexico
New Mexico · 33992
Office
Unavailable
Facility
$168.68
No comparable office rate is available.
Nevada**
Nevada · 33992
Office
Unavailable
Facility
$160.45
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 33992
Office
Unavailable
Facility
$200.04
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 33992
Office
Unavailable
Facility
$178.05
No comparable office rate is available.
Queens
New York · 33992
Office
Unavailable
Facility
$188.51
No comparable office rate is available.
Rest Of New York
New York · 33992
Office
Unavailable
Facility
$155.76
No comparable office rate is available.
Ohio
Ohio · 33992
Office
Unavailable
Facility
$163.30
No comparable office rate is available.
Oklahoma
Oklahoma · 33992
Office
Unavailable
Facility
$156.53
No comparable office rate is available.
Portland
Oregon · 33992
Office
Unavailable
Facility
$162.28
No comparable office rate is available.
Rest Of Oregon
Oregon · 33992
Office
Unavailable
Facility
$156.78
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 33992
Office
Unavailable
Facility
$173.27
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 33992
Office
Unavailable
Facility
$161.69
No comparable office rate is available.
Puerto Rico
Puerto Rico · 33992
Office
Unavailable
Facility
$164.83
No comparable office rate is available.
Rhode Island
Rhode Island · 33992
Office
Unavailable
Facility
$164.97
No comparable office rate is available.
South Carolina
South Carolina · 33992
Office
Unavailable
Facility
$159.22
No comparable office rate is available.
South Dakota**
South Dakota · 33992
Office
Unavailable
Facility
$146.81
No comparable office rate is available.
Tennessee
Tennessee · 33992
Office
Unavailable
Facility
$150.31
No comparable office rate is available.
Austin
Texas · 33992
Office
Unavailable
Facility
$163.39
No comparable office rate is available.
Beaumont
Texas · 33992
Office
Unavailable
Facility
$161.07
No comparable office rate is available.
Brazoria
Texas · 33992
Office
Unavailable
Facility
$159.70
No comparable office rate is available.
Dallas
Texas · 33992
Office
Unavailable
Facility
$162.06
No comparable office rate is available.
Fort Worth
Texas · 33992
Office
Unavailable
Facility
$162.20
No comparable office rate is available.
Galveston
Texas · 33992
Office
Unavailable
Facility
$161.06
No comparable office rate is available.
Houston
Texas · 33992
Office
Unavailable
Facility
$176.07
No comparable office rate is available.
Rest Of Texas
Texas · 33992
Office
Unavailable
Facility
$161.22
No comparable office rate is available.
Utah
Utah · 33992
Office
Unavailable
Facility
$160.88
No comparable office rate is available.
Virginia
Virginia · 33992
Office
Unavailable
Facility
$156.57
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 33992
Office
Unavailable
Facility
$164.83
No comparable office rate is available.
Vermont
Vermont · 33992
Office
Unavailable
Facility
$151.25
No comparable office rate is available.
Rest Of Washington
Washington · 33992
Office
Unavailable
Facility
$161.13
No comparable office rate is available.
Seattle (King Cnty)
Washington · 33992
Office
Unavailable
Facility
$170.77
No comparable office rate is available.
Wisconsin
Wisconsin · 33992
Office
Unavailable
Facility
$145.12
No comparable office rate is available.
West Virginia
West Virginia · 33992
Office
Unavailable
Facility
$173.92
No comparable office rate is available.
See how rates vary across the country
33992 · 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?
Wyoming** is a Medicare payment area. Our Census mapping connects it to 205 cities and communities in Wyoming, 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 33992 in Wyoming**. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$173.67
$157.88 × 110% = $173.67
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 33992 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
4,176
- Code
- 33992
- Physician work
- 3.46
- Practice expense
- 0.66
- Malpractice
- 0.82
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.46 | × 1.000 | 3.4600 |
| Practice expense | 0.66 | × 1.000 | 0.6600 |
| Malpractice | 0.82 | × 0.740 | 0.6068 |
| Total RVUs | 4.7268 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$157.88
Open 33992 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.46 | 1 |
| Practice expense | 0.66 | 1 |
| Malpractice | 0.82 | 0.74 |
(3.46 × 1 + 0.66 × 1 + 0.82 × 0.74) × $33.4009 = $157.88
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
33992 · 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 | $157.88 | RVU26D |
| 2026-07-01 | Not available in this setting | $157.88 | RVU26C |
| 2026-04-01 | Not available in this setting | $157.88 | RVU26B |
| 2026-01-01 | Not available in this setting | $157.88 | RVU26A |
| 2025-10-01 | Not available in this setting | $171.39 | RVU25D |
| 2025-07-01 | Not available in this setting | $171.39 | RVU25C |
| 2025-04-01 | Not available in this setting | $171.39 | RVU25B |
| 2025-01-01 | Not available in this setting | $171.39 | RVU25A |
33992 billing questions
How is removal distinguished from repositioning?
Report 33992 when the percutaneous left-heart VAD is removed. Code 33993 describes repositioning a percutaneous right- or left-heart VAD, not removal.
Is 33992 used for VAD insertion?
No. Codes 33990 and 33991 describe percutaneous left-heart VAD insertion, with different access configurations; 33992 describes removal.
When does 33997 apply instead?
Use 33997 for removal of a percutaneous right-heart VAD. Code 33992 is specific to a percutaneous left-heart VAD.
Can modifier 50 be used for this removal?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the multiple procedure rule affect payment?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction.
What documentation supports reporting 33992?
Document that the device was a percutaneous left-heart VAD and that it was removed. The record should distinguish removal from repositioning or removal of a right-heart device.
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.
4,17333989,,Removal of left heart vent,A,,9.26,2.05,NA,2.05,,2.21,13.52,13.52,0,000,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17433990,,Insj perq vad l hrt arterial,A,,6.58,1.26,NA,1.26,,1.53,9.37,9.37,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17533991,,Insj perq vad l hrt artl&ven,A,,8.62,1.77,NA,1.77,,2.06,12.45,12.45,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17633992,,Rmvl perq left heart vad,A,,3.46,0.66,NA,0.66,,0.82,4.94,4.94,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17733993,,Reposg perq r/l hrt vad,A,,3.02,0.66,NA,0.66,,0.58,4.26,4.26,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17833995,,Insj perq vad r hrt venous,A,,6.58,1.28,NA,1.28,,1.50,9.36,9.36,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17933997,,Rmvl perq right heart vad,A,,2.93,0.58,NA,0.58,,0.67,4.18,4.18,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,