Billing code 33269: LAA exclusionMedicare rate & RVUs in Georgia
Reports surgical exclusion of the left atrial appendage using a thoracoscopic approach, such as epicardial clipping or ligation.
CMS doesn’t publish an office rate for 33269 in Georgia.
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 33269 covers
This code describes surgical exclusion of the left atrial appendage through a thoracoscopic approach. A cardiac surgeon typically performs the procedure in an operating room, using thoracoscopic access to close off the appendage from outside the heart; methods may include clipping or ligation. The code distinguishes this minimally invasive surgical approach from open exclusion and catheter-based closure. It may be performed as a stand-alone operation or alongside other cardiac surgery when the thoracoscopic approach is used for the appendage exclusion.
Select the code based on the documented thoracoscopic approach and the work to exclude the appendage, not merely because the patient has atrial fibrillation or an appendage device. The operative report should identify the approach and the exclusion method. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code’s descriptor and anatomy. An assistant at surgery may be paid; 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.
Where 33269 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | Unavailable | $824.00 |
| Rest Of Georgia | Unavailable | $794.97 |
How the 33269 rate is calculated
Each of 33269’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 · 33269
RVUs × geographic indexes × conversion factor
Work13.95
13.95 RVUs× 1.000 GPCI
Practice expense6.42
6.42 RVUs× 1.000 GPCI
Malpractice3.46
3.46 RVUs× 1.000 GPCI
Adjusted RVUs
23.8300
Conversion factor
$33.4009
Medicare rate
$795.94
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33269
33269 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33269
LAA exclusion
| 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) | 2 | Paid. |
| 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) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 33269
LAA exclusion
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
33269 without 51 · national facility
$795.94
LAA exclusion
33269-51 · Second procedure: 50%
$397.97
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%).
33269 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33267LAA exclusion
- Choose 33269 for thoracoscopic appendage exclusion and 33267 for the open approach.
- 33268LAA exclusion
- 33268 is for open appendage exclusion during another open cardiac procedure; 33269 identifies thoracoscopic exclusion.
- 33340Appendage closure
- 33340 describes transcatheter appendage closure with an endocardial implant, not thoracoscopic surgical exclusion.
33269 billing questions
How does this code differ from 33267?
33269 describes thoracoscopic left atrial appendage exclusion. Code 33267 describes open exclusion, so use the approach documented in the operative report.
How does this code differ from 33268?
33268 describes open appendage exclusion performed with another open cardiac procedure. This code is for thoracoscopic exclusion.
Can this code describe catheter-based appendage closure?
No. It identifies surgical exclusion through thoracoscopic access; transcatheter closure is a different approach.
What documentation supports reporting this code?
The operative report should document thoracoscopic access and the method used to exclude the left atrial appendage.
How is the 90-day global period handled?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. 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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