Billing code 33259: Atrial ablationMedicare rate & RVUs in Guam
Reports extensive surgical ablation for atrial fibrillation performed with cardiopulmonary bypass during another cardiac operation, as an add-on to that procedure.
CMS doesn’t publish an office rate for 33259 in Guam.
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 33259 covers
This add-on covers an extensive surgical lesion set in the atria to treat atrial fibrillation while the patient is undergoing another cardiac operation with cardiopulmonary bypass. A cardiac surgeon typically performs it in the operating room during open-heart surgery, such as mitral valve surgery or coronary artery bypass grafting. The ablation is performed alongside the primary operation rather than as a standalone service.
Report 33259 only with the primary cardiac procedure when the operative record supports extensive atrial ablation and cardiopulmonary bypass. Documentation should identify the atrial ablation performed, its extent, use of bypass, and the primary operation. Distinguish it from limited ablation and extensive ablation without bypass when selecting among related codes. CMS treats this as an add-on: it is billed with a primary procedure and paid within that procedure's global period.
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.
33259 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $807.75 |
How the 33259 rate is calculated
Each of 33259’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 · 33259
RVUs × geographic indexes × conversion factor
Work13.79
13.79 RVUs× 1.000 GPCI
Practice expense7.43
7.43 RVUs× 1.000 GPCI
Malpractice3.36
3.36 RVUs× 1.000 GPCI
Adjusted RVUs
24.5800
Conversion factor
$33.4009
Medicare rate
$820.99
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33259
The CMS indicators that decide how 33259 is paid alongside other services.
CMS payment indicators · 33259
Atrial ablation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
33259 without 80 · national facility
$820.99
Atrial ablation
33259-80 · Assistant: 16%
$131.36
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
33259 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33258Atrial ablation
- Choose 33259 for extensive atrial ablation with cardiopulmonary bypass during another cardiac procedure; 33258 represents the corresponding add-on without bypass.
- 33257Atrial ablation
- 33257 is the limited-ablation add-on with bypass. 33259 is for an extensive atrial ablation with bypass.
- 33256Atrial ablation
- Both concern extensive atrial ablation with cardiopulmonary bypass. 33259 is the add-on used during another cardiac procedure; 33256 is the related base procedure code.
33259 billing questions
Can 33259 be billed by itself?
No. It is an add-on for extensive atrial ablation performed with cardiopulmonary bypass during another cardiac procedure, and must be reported with the primary procedure.
How does 33259 differ from 33258?
Both represent extensive atrial ablation as an add-on during another cardiac procedure. 33259 is the choice when cardiopulmonary bypass is used; 33258 is for the corresponding service without bypass.
When is 33257 a better choice?
Use 33257 for limited atrial ablation with cardiopulmonary bypass during another cardiac procedure. 33259 describes an extensive ablation with bypass.
Does cardiopulmonary bypass alone support 33259?
No. The record must support the extensive atrial ablation as well as use of bypass during the primary cardiac operation.
What should the operative report document?
Document the atrial ablation and its extent, whether cardiopulmonary bypass was used, and the concurrent primary cardiac procedure.
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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