Billing code 33503: Coronary repairMedicare rate & RVUs in Delaware
Reports surgical bypass grafting to restore blood flow when a coronary artery arises anomalously from the pulmonary artery, as in ALCAPA.
CMS doesn’t publish an office rate for 33503 in Delaware.
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 9 sections
What 33503 covers
This operation creates a bypass graft to supply blood to a coronary artery that originates from the pulmonary artery. It is used for congenital coronary anomalies, including anomalous left coronary artery from the pulmonary artery (ALCAPA), which can impair oxygen delivery to the heart muscle. A cardiothoracic or congenital heart surgeon performs the repair in an operating room; the operative report should establish the anomalous origin and describe the graft-based repair.
Report this code for the bypass repair, rather than a code for a different correction technique or routine bypass for acquired coronary disease. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. If other procedures are performed 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 anatomy. Assistant-at-surgery payment requires medical-necessity documentation; co-surgeon payment requires supporting documentation, and team surgery is 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.
33503 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $1,258.28 |
How the 33503 rate is calculated
Each of 33503’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 · 33503
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 21.95Practice expense 10.77Malpractice 5.53
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 33503
33503 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33503
Coronary repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 33503
Coronary repair
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33503 without 51 · national facility
$1,277.58
Coronary repair
33503-51 · Second procedure: 50%
$638.79
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%).
33503 compared with similar codes
Compare codes
33503 vs 33502 vs 33504 vs 33510 vs 33533: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 33502Coronary repair
- Use 33503 when the anomalous coronary artery is repaired with bypass grafting. Code 33502 represents the ligation-based repair approach.
- 33504Coronary repair
- Both concern an anomalous coronary artery arising from the pulmonary artery, but 33504 represents a different repair technique. Follow the operative description rather than treating the codes as interchangeable.
- 33510Coronary bypass
- 33510 is for single venous-graft CABG in a different clinical context. 33503 is specific to bypass repair of a coronary artery with anomalous pulmonary origin.
- 33533Arterial CABG
- 33533 describes single arterial-graft CABG for a different clinical context; 33503 addresses the congenital anomalous-origin repair.
33503 billing questions
When is 33503 different from 33502?
33503 describes bypass grafting to address a coronary artery arising from the pulmonary artery. Select 33502 when the documented repair is the ligation-based technique instead.
How does 33503 differ from 33504?
These codes distinguish surgical approaches to an anomalous coronary artery from the pulmonary artery. Use 33503 for a bypass graft repair; use 33504 when the operative report supports its distinct repair technique.
Can modifier 50 be used?
No. Bilateral adjustment is not appropriate for this anatomy, so modifier 50 should not be appended.
What documentation supports reporting 33503?
The operative report should identify the coronary artery's anomalous pulmonary origin and describe the bypass graft used to restore coronary blood flow.
How are other procedures in the same session paid?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures performed in that session are subject to a 50% payment reduction.
What documentation is needed for an assistant or co-surgeon?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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
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