No office rate
33406 describes aortic valve replacement using a homograft. This code describes preparation of the recipient conduit, which may be performed during that replacement operation.
On this page
CMS RVU26D · Effective 2026-10-01
33404 Conduit preparation Medicare reimbursement rates in Guam
Reports the surgeon’s preparation of the heart-aorta conduit to receive an aortic valve homograft during open aortic valve surgery. Compare 33404 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 33404 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
$1616.17
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 33404: Aortic homograft conduit preparation
Reports the surgeon’s preparation of the heart-aorta conduit to receive an aortic valve homograft during open aortic valve surgery.
This service covers preparing the recipient heart and aortic outflow tract for an aortic valve homograft during open cardiac surgery. A cardiac surgeon performs the work, typically in an operating room with cardiopulmonary bypass as part of a valve replacement operation. The preparation is distinct from the act of implanting the replacement valve; the operative report should make clear what conduit preparation was performed and how it relates to the valve procedure.
Report the code when the documented operation includes this specific preparation, not simply because a homograft is implanted. Identify the graft type, the relevant anatomy, and the preparation performed. The procedure has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple 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. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation. Team surgery is not permitted.
CMS billing rules for 33404
- 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 RVU30.59 · 61%
- Practice expense (office) RVU11.92 · 24%
- Malpractice RVU7.33 · 15%
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.
33404 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
33405 describes replacement with a prosthetic valve. This code concerns conduit preparation for a homograft rather than prosthetic valve implantation.
No office rate
33410 describes aortic valve replacement using the patient’s pulmonary valve. This code concerns preparation of the heart-aorta conduit for homograft insertion.
Compare 33404 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
$1616.17
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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 33404 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,935
- Code
- 33404
- Physician work
- 30.59
- Practice expense
- 11.92
- Malpractice
- 7.33
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 30.59 | × 1.000 | 30.5900 |
| Practice expense | 11.92 | × 1.137 | 13.5530 |
| Malpractice | 7.33 | × 0.579 | 4.2441 |
| Total RVUs | 48.3871 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$1616.17
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 30.59 | 1 |
| Practice expense | 11.92 | 1.137 |
| Malpractice | 7.33 | 0.579 |
(30.59 × 1 + 11.92 × 1.137 + 7.33 × 0.579) × $33.4009 = $1616.17
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.
33404 billing questions
How does this differ from the aortic valve replacement code?
This code represents preparation of the recipient heart-aorta conduit. A separate replacement code describes the valve replacement itself; the operative report should support each reported service.
When is this reported with an aortic homograft replacement?
Report it when the surgeon performs the specified conduit preparation during the operation. Document the preparation separately from the act of implanting the homograft.
Does the code have a 90-day global period?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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.
Should modifier 50 be used?
No. Bilateral adjustment does not apply to this code.
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.
3,93233370,,Tcat plmt&rmvl cepd perq,A,,2.44,0.46,NA,0.46,,0.57,3.47,3.47,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,93333390,,Valvuloplasty aortic valve,A,,34.13,10.62,NA,10.62,,8.31,53.06,53.06,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,93433391,,Valvuloplasty aortic valve,A,,40.46,13.28,NA,13.28,,9.71,63.45,63.45,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,93533404,,Prepare heart-aorta conduit,A,,30.59,11.92,NA,11.92,,7.33,49.84,49.84,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,93633405,,Replacement aortic valve opn,A,,40.29,13.38,NA,13.38,,9.98,63.65,63.65,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,93733406,,Replacement aortic valve opn,A,,51.36,15.89,NA,15.89,,12.97,80.22,80.22,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,9383340F,,Mammo assess inc xray 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
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