No office rate
Use 33405 for aortic valve replacement with a prosthetic valve. Use 33440 when the pulmonary valve is moved into the aortic position as an autograft.
On this page
CMS RVU26D · Effective 2026-10-01
33440 Aortic valve replacement Medicare reimbursement rates in California
Report this code for open aortic valve replacement using the patient’s pulmonary valve as an autograft, with reconstruction of the pulmonary valve position. Compare 33440 office and facility rates across CMS payment localities in California.
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 33440 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$3027.36–$3423.09
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $395.73 per service.
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.
Where 33440 pays more and less in California
Cardiac surgery
About 33440: Aortic valve replacement with pulmonary autograft
Report this code for open aortic valve replacement using the patient’s pulmonary valve as an autograft, with reconstruction of the pulmonary valve position.
The Ross procedure replaces a diseased aortic valve by moving the patient’s own pulmonary valve into the aortic position. The surgeon then reconstructs the pulmonary valve position, commonly with a donor pulmonary valve or conduit. Cardiothoracic surgeons perform this open operation in a hospital operating room, typically for patients who need aortic valve replacement and are candidates for use of their own pulmonary valve tissue.
Select this code when the operative report documents the pulmonary autograft’s translocation to the aortic position, rather than replacement with a prosthetic valve or an allograft. Documentation should identify the valve procedure and describe the pulmonary valve reconstruction. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For other procedures performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Report the single valve operation without modifier 50. An assistant may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 33440
- 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 RVU62.40 · 66%
- Practice expense (office) RVU17.47 · 18%
- Malpractice RVU14.98 · 16%
30
Medicare services in 2024 · #5669 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.
33440 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
Code 33406 describes aortic valve replacement with an allograft. Code 33440 describes translocation of the patient’s pulmonary valve.
No office rate
Code 33414 is for aortic valve repair; 33440 is for replacement through the Ross procedure.
Compare 33440 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.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $3068.06 |
| Chico | Office Unavailable | Facility $3027.36 |
| El Centro | Office Unavailable | Facility $3029.87 |
| Fresno | Office Unavailable | Facility $3027.36 |
| Hanford-Corcoran | Office Unavailable | Facility $3027.36 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $3192.20 |
| Madera | Office Unavailable | Facility $3027.36 |
| Merced | Office Unavailable | Facility $3027.36 |
| Modesto | Office Unavailable | Facility $3027.36 |
| Napa | Office Unavailable | Facility $3238.77 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $3144.00 |
| Redding | Office Unavailable | Facility $3027.36 |
| Rest Of California | Office Unavailable | Facility $3027.36 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $3188.06 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $3106.06 |
| Salinas | Office Unavailable | Facility $3093.30 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $3115.81 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $3334.63 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $3317.62 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $3423.09 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $3353.54 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $3052.46 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $3105.14 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $3091.14 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $3131.48 |
| Stockton | Office Unavailable | Facility $3027.36 |
| Vallejo | Office Unavailable | Facility $3214.25 |
| Visalia | Office Unavailable | Facility $3027.36 |
| Yuba City | Office Unavailable | Facility $3027.36 |
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33440 billing questions
How is this different from a standard prosthetic aortic valve replacement?
This code is for a Ross procedure: the patient’s pulmonary valve is moved to the aortic position. A prosthetic valve replacement uses a valve prosthesis instead.
Is the pulmonary valve reconstruction part of this operation?
Yes. Reconstruction of the pulmonary valve position is part of the Ross procedure; the operative report should describe how that position was reconstructed.
Should modifier 50 be reported?
No. Report the single aortic valve operation without modifier 50; the procedure is not a bilateral service.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
How does the 90-day global period affect postoperative billing?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. For other procedures in the same session, the highest-valued procedure is paid in full and the others at 50%.
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.
3,9553342F,,Mammo assess bengn docd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3,95633430,,Replacement of mitral valve,A,,49.66,16.62,NA,16.62,,12.25,78.53,78.53,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,9573343F,,Mammo probably bengn docd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3,95833440,,Rplcmt a-valve tlcj autol pv,A,,62.40,17.47,NA,17.47,,14.98,94.85,94.85,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,9593344F,,Mammo assess susp docd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3,9603345F,,Mammo assess hghlymalig doc,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96133460,,Revision of tricuspid valve,A,,43.58,13.15,NA,13.15,,10.46,67.19,67.19,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00