No office rate
33474 is for surgical revision of the pulmonary valve; 33475 is for replacement of the valve.
On this page
CMS RVU26D · Effective 2026-10-01
33474 Pulmonary valve surgery Medicare reimbursement rates in Guam
Report surgical revision of the pulmonary valve to correct valve dysfunction when the surgeon repairs the valve rather than replacing it. Compare 33474 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 33474 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
$1960.19
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 33474: Surgical pulmonary valve repair
Report surgical revision of the pulmonary valve to correct valve dysfunction when the surgeon repairs the valve rather than replacing it.
A cardiothoracic surgeon uses this code for an operation that revises the pulmonary valve, such as correcting valve narrowing or leakage while retaining the valve. These procedures are performed in a cardiac surgery setting, often for congenital or acquired pulmonary valve disease. The operative report should identify the pulmonary valve abnormality and describe the repair performed.
Choose this code when the surgeon revises the pulmonary valve; use a replacement code when the valve is removed and replaced. The note should distinguish valve work from any separate work on a heart chamber or another valve. 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 other procedures are subject to the standard reduction. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 33474
- 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 RVU38.42 · 63%
- Practice expense (office) RVU12.88 · 21%
- Malpractice RVU9.71 · 16%
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.
33474 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
33474 describes surgical revision. 33477 describes transcatheter implantation of a pulmonary valve.
No office rate
33474 addresses the pulmonary valve itself. 33476 is for revision of a heart chamber, not valve revision.
Compare 33474 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
$1960.19
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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 33474 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,966
- Code
- 33474
- Physician work
- 38.42
- Practice expense
- 12.88
- Malpractice
- 9.71
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 38.42 | × 1.000 | 38.4200 |
| Practice expense | 12.88 | × 1.137 | 14.6446 |
| Malpractice | 9.71 | × 0.579 | 5.6221 |
| Total RVUs | 58.6867 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$1960.19
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 38.42 | 1 |
| Practice expense | 12.88 | 1.137 |
| Malpractice | 9.71 | 0.579 |
(38.42 × 1 + 12.88 × 1.137 + 9.71 × 0.579) × $33.4009 = $1960.19
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.
33474 billing questions
How does 33474 differ from pulmonary valve replacement?
Use 33474 when the surgeon revises the pulmonary valve without replacing it. When the valve is removed and replaced, consider 33475.
How does surgical revision differ from transcatheter pulmonary valve implantation?
33474 describes surgical valve revision. Code 33477 is for transcatheter pulmonary valve implantation, a different approach.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code because of the descriptor or anatomy.
What documentation supports reporting 33474?
The operative report should identify the pulmonary valve condition and describe the revision, making clear whether the surgeon repaired the valve or replaced it.
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 are subject to the reduction. Related postoperative care falls within the 90-day global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. 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 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.
3,96333464,,Valvuloplasty tricuspid,A,,43.50,14.11,NA,14.11,,10.43,68.04,68.04,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96433465,,Replace tricuspid valve,A,,49.45,15.21,NA,15.21,,12.10,76.76,76.76,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96533468,,Revision of tricuspid valve,A,,44.00,12.89,NA,12.89,,11.12,68.01,68.01,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96633474,,Revision of pulmonary valve,A,,38.42,12.88,NA,12.88,,9.71,61.01,61.01,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96733475,,Replacement pulmonary valve,A,,41.34,13.19,NA,13.19,,9.80,64.33,64.33,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96833476,,Revision of heart chamber,A,,25.91,10.93,NA,10.93,,6.53,43.37,43.37,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96933477,,Implant tcat pulm vlv perq,A,,24.38,5.11,NA,5.11,,4.23,33.72,33.72,0,000,0.00,0.00,0.00,2,0,0,1,1,9,,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