Billing code 33954: ECMO cannulationMedicare rate & RVUs in Guam
Reports percutaneous placement of peripheral cannulae for ECMO or ECLS in a patient age six or older as part of extracorporeal support.
CMS doesn’t publish an office rate for 33954 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 33954 covers
This service covers percutaneous placement of peripheral cannulae to establish extracorporeal membrane oxygenation or extracorporeal life support in patients age six and older. A cardiothoracic or vascular surgeon, or another physician qualified to perform the access, places cannulae through peripheral vessels; femoral vessels are common access sites. The service is performed in settings such as an operating room or intensive care unit when urgent circulatory or respiratory support is needed.
Select this code for percutaneous peripheral cannulation in the specified age group; use the applicable sibling code when the age group or insertion approach differs. Document the patient’s age, peripheral access site, percutaneous technique, and cannula placement. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are 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.
33954 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $411.27 |
How the 33954 rate is calculated
Each of 33954’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 · 33954
RVUs × geographic indexes × conversion factor
Work8.88
8.88 RVUs× 1.000 GPCI
Practice expense1.95
1.95 RVUs× 1.000 GPCI
Malpractice2.10
2.10 RVUs× 1.000 GPCI
Adjusted RVUs
12.9300
Conversion factor
$33.4009
Medicare rate
$431.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33954
The CMS indicators that decide how 33954 is paid alongside other services.
CMS payment indicators · 33954
ECMO cannulation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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) | 0 | Not paid without supporting documentation. |
| 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 51 · payment effect
With and without the modifier
33954 without 51 · national facility
$431.87
ECMO cannulation
33954-51 · Second procedure: 50%
$215.94
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%).
33954 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33951ECMO cannulation
- Both codes concern peripheral cannula insertion, but 33954 identifies the percutaneous approach for patients age six and older. Apply the sibling code criteria when the approach or age group differs.
- 33955Central cannulation
- 33954 covers percutaneous peripheral cannula placement; 33955 is in the central cannula insertion family.
- 33946ECMO initiation
- 33954 reports the percutaneous peripheral cannula placement. Code 33946 reports veno-venous ECMO/ECLS initiation, a distinct service when performed.
33954 billing questions
How does 33954 differ from 33951?
33954 is for percutaneous peripheral cannula insertion in a patient age six or older. Choose 33951 when the insertion approach and the patient’s age match that code’s criteria instead.
When should a central cannula insertion code be used instead?
Use the central cannula insertion family when cannulae are placed centrally rather than through peripheral vessels. Code 33954 describes percutaneous peripheral access.
Can this be reported with an ECMO/ECLS initiation code?
Peripheral cannula placement may be reported with the applicable initiation service when both services are performed and documented. Select the initiation code for the veno-venous or veno-arterial circuit.
Can modifier 50 be appended for cannulation on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What documentation supports 33954?
Record the patient’s age, the peripheral vessel access site, the percutaneous approach, and the cannula placement performed for ECMO/ECLS.
May an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are 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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