No office rate
Use 33365 for transapical delivery through the heart’s apex; use 33361 when the catheter is introduced percutaneously through a femoral artery.
On this page
CMS RVU26D · Effective 2026-10-01
33365 Aortic valve replacement Medicare reimbursement rates in Alabama
Reports transcatheter aortic valve replacement delivered through the heart’s apex when the documented access route is transapical. Compare 33365 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 33365 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1158.41
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Structural heart intervention
About 33365: Transapical transcatheter aortic valve replacement
Reports transcatheter aortic valve replacement delivered through the heart’s apex when the documented access route is transapical.
This service replaces the aortic valve with a catheter-delivered prosthesis introduced through the apex of the heart, typically using a surgical chest approach. A cardiac surgeon and interventional cardiology team may perform the procedure in a hospital hybrid operating room or catheterization suite. The transapical route is distinct from delivery through a peripheral artery and from conventional open valve replacement, in which the surgeon directly replaces the valve.
Report this code when the operative documentation supports transapical access and transcatheter valve deployment. Record the access route, valve procedure, and any additional procedures performed during the session. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity; co-surgeons are permitted, and team-surgery payment requires supporting documentation. Modifier 50 is inappropriate for this procedure.
CMS billing rules for 33365
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery paid only with supporting documentation.
Where the value comes from
- Work RVU25.93 · 68%
- Practice expense (office) RVU5.94 · 16%
- Malpractice RVU6.28 · 16%
157
Medicare services in 2024 · #4528 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.
33365 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
33362 identifies TAVR through an open femoral artery approach. The transapical route through the heart’s apex is reported with 33365.
No office rate
33366 is the sibling code for a different TAVR access route. Select between these codes based on the route documented in the operative report.
No office rate
33365 describes catheter-based valve replacement using transapical access; 33405 is conventional surgical replacement of the aortic valve.
Compare 33365 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$1158.41
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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 33365 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
3,927
- Code
- 33365
- Physician work
- 25.93
- Practice expense
- 5.94
- Malpractice
- 6.28
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 25.93 | × 1.000 | 25.9300 |
| Practice expense | 5.94 | × 0.875 | 5.1975 |
| Malpractice | 6.28 | × 0.566 | 3.5545 |
| Total RVUs | 34.6820 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$1158.41
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 25.93 | 1 |
| Practice expense | 5.94 | 0.875 |
| Malpractice | 6.28 | 0.566 |
(25.93 × 1 + 5.94 × 0.875 + 6.28 × 0.566) × $33.4009 = $1158.41
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.
33365 billing questions
How does 33365 differ from 33361?
33365 identifies transapical delivery through the heart’s apex. 33361 is for transcatheter valve delivery through a percutaneous femoral artery approach.
Is this code for conventional open aortic valve replacement?
No. It describes catheter-based valve replacement using transapical access, not direct surgical replacement of the valve.
What documentation supports 33365?
The operative report should identify the transapical access route and document transcatheter prosthetic valve deployment. Document other procedures performed in the same session separately as applicable.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons are permitted; team-surgery payment requires supporting documentation.
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.
Can modifier 50 be used?
No. The aortic-valve procedure and its anatomy make a bilateral adjustment 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 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.
3,92433362,,Replace aortic valve open,A,,23.93,5.48,NA,5.48,,5.78,35.19,35.19,0,000,0.00,0.00,0.00,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92533363,,Replace aortic valve open,A,,24.83,5.71,NA,5.71,,6.02,36.56,36.56,0,000,0.00,0.00,0.00,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92633364,,Replace aortic valve open,A,,25.32,6.48,NA,6.48,,6.07,37.87,37.87,0,000,0.00,0.00,0.00,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92733365,,Replace aortic valve open,A,,25.93,5.94,NA,5.94,,6.28,38.15,38.15,0,000,0.00,0.00,0.00,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92833366,,Trcath replace aortic valve,A,,28.62,6.45,NA,6.45,,6.86,41.93,41.93,0,000,0.00,0.00,0.00,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92933367,,Replace aortic valve w/byp,A,,11.58,2.38,NA,2.38,,2.76,16.72,16.72,0,ZZZ,0.00,0.00,0.00,0,0,0,0,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,93033368,,Replace aortic valve w/byp,A,,14.03,2.88,NA,2.88,,3.35,20.26,20.26,0,ZZZ,0.00,0.00,0.00,0,0,0,0,1,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515