No office rate
Choose 33257 for limited atrial ablation performed with another open cardiac procedure. Code 33258 is for the more extensive lesion set.
On this page
CMS RVU26D · Effective 2026-10-01
33258 Atrial ablation Medicare reimbursement rates in Guam
Add-on extensive atrial ablation performed during another open cardiac operation to treat atrial fibrillation, without cardiopulmonary bypass. Compare 33258 office and facility rates across CMS payment localities in Guam.
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 33258 in Guam?
Guam 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
$626.46
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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.
Cardiac surgery
About 33258: Extensive atrial ablation during cardiac surgery
Add-on extensive atrial ablation performed during another open cardiac operation to treat atrial fibrillation, without cardiopulmonary bypass.
Code 33258 represents an extensive set of surgical lesions in atrial tissue to interrupt pathways sustaining atrial fibrillation. A cardiac surgeon may perform it during another open cardiac operation, such as valve surgery or coronary artery bypass, using the operative exposure. It describes an adjunct to that operation, not a standalone ablation session, and distinguishes an extensive lesion set from a limited one.
Report it only with an eligible primary open cardiac procedure; CMS treats the add-on service within that procedure’s global period. The operative report should support the atrial fibrillation treatment, extent of the lesion set, concurrent cardiac operation, and absence of cardiopulmonary bypass. Use the extensive add-on code for this situation; a limited lesion set or use of bypass points to a different code in the family.
CMS billing rules for 33258
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU10.73 · 56%
- Practice expense (office) RVU5.75 · 30%
- Malpractice RVU2.57 · 13%
65
Medicare services in 2024 · #5186 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.
33258 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
Both describe extensive atrial ablation as an add-on during another open cardiac procedure. Use 33259 when cardiopulmonary bypass is used; 33258 is for cases without bypass.
No office rate
33255 describes extensive surgical atrial ablation without bypass when it is not reported as the add-on during another open cardiac procedure.
No office rate
33266 is the extensive endoscopic approach. Code 33258 describes the open surgical approach without cardiopulmonary bypass.
Compare 33258 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$626.46
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 33258 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,881
- Code
- 33258
- Physician work
- 10.73
- Practice expense
- 5.75
- Malpractice
- 2.57
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.73 | × 1.000 | 10.7300 |
| Practice expense | 5.75 | × 1.137 | 6.5377 |
| Malpractice | 2.57 | × 0.579 | 1.4880 |
| Total RVUs | 18.7558 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$626.46
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.73 | 1 |
| Practice expense | 5.75 | 1.137 |
| Malpractice | 2.57 | 0.579 |
(10.73 × 1 + 5.75 × 1.137 + 2.57 × 0.579) × $33.4009 = $626.46
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.
33258 billing questions
Can 33258 be reported by itself?
No. It is an add-on for extensive atrial ablation performed with another eligible open cardiac procedure, and CMS places it within that primary procedure’s global period.
How does 33258 differ from 33257?
33258 describes an extensive lesion set; 33257 is for limited atrial ablation performed during another open cardiac procedure.
When should 33259 be used instead?
Use 33259 for the extensive add-on when cardiopulmonary bypass is used. Code 33258 is the extensive add-on without bypass.
What documentation supports reporting 33258?
The operative report should establish atrial fibrillation treatment, an extensive atrial lesion set, the concurrent open cardiac operation, and whether cardiopulmonary bypass was used.
Can it accompany valve surgery or bypass surgery?
It may be reported as an add-on when extensive atrial ablation is performed during an eligible open cardiac operation, such as valve surgery or coronary artery bypass.
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.
3,87833255,,Ablate atria w/o bypass ext,A,,28.31,11.34,NA,11.34,,6.77,46.42,46.42,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,87933256,,Ablate atria w/bypass exten,A,,34.03,12.52,NA,12.52,,8.15,54.70,54.70,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,88033257,,Ablate atria lmtd add-on,A,,9.39,5.32,NA,5.32,,2.33,17.04,17.04,0,ZZZ,0.00,0.00,0.00,0,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,88133258,,Ablate atria x10sv add-on,A,,10.73,5.75,NA,5.75,,2.57,19.05,19.05,0,ZZZ,0.00,0.00,0.00,0,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,88233259,,Ablate atria w/bypass add-on,A,,13.79,7.43,NA,7.43,,3.36,24.58,24.58,0,ZZZ,0.00,0.00,0.00,0,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,8833325F,,Preop asses 4 cataract surg,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
3,88433261,,Ablate heart dysrhythm focus,A,,28.20,10.97,NA,10.97,,6.75,45.92,45.92,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014