No office rate
Both describe open LAA exclusion, but 33267 is for a standalone service; 33268 is used when exclusion is performed during another cardiac procedure.
On this page
CMS RVU26D · Effective 2026-10-01
33267 LAA exclusion Medicare reimbursement rates in Hawaii
Reports open surgical exclusion of the left atrial appendage as a standalone service, using a method such as suturing, stapling, or excision. Compare 33267 office and facility rates across CMS payment localities in Hawaii.
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 33267 in Hawaii?
Hawaii 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
$959.00
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 33267: Open left atrial appendage exclusion
Reports open surgical exclusion of the left atrial appendage as a standalone service, using a method such as suturing, stapling, or excision.
The surgeon excludes the left atrial appendage through an open approach, using the method appropriate to the operation, such as suturing, stapling, or excision. This service is used in selected patients with atrial fibrillation as part of surgical stroke-risk management. Cardiothoracic surgeons typically perform it in an operating room, either as a standalone procedure or alongside other cardiac surgery; when it accompanies another cardiac procedure, the related add-on code distinguishes that circumstance.
Select this code for open LAA exclusion performed as a standalone service, not for a thoracoscopic approach or exclusion performed during another cardiac procedure. The operative report should identify the open approach, the appendage treated, the exclusion method, and whether another cardiac procedure was performed in the same session. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 33267
- 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 RVU18.04 · 61%
- Practice expense (office) RVU7.13 · 24%
- Malpractice RVU4.43 · 15%
323
Medicare services in 2024 · #3940 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.
33267 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
Choose 33267 for open surgical access and 33269 for a thoracoscopic approach.
No office rate
33254 reports limited atrial ablation, not LAA exclusion. Report 33267 only when the appendage itself is surgically excluded by an open approach.
Compare 33267 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
$959.00
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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 33267 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,890
- Code
- 33267
- Physician work
- 18.04
- Practice expense
- 7.13
- Malpractice
- 4.43
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.04 | × 1.000 | 18.0400 |
| Practice expense | 7.13 | × 1.137 | 8.1068 |
| Malpractice | 4.43 | × 0.579 | 2.5650 |
| Total RVUs | 28.7118 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$959.00
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18.04 | 1 |
| Practice expense | 7.13 | 1.137 |
| Malpractice | 4.43 | 0.579 |
(18.04 × 1 + 7.13 × 1.137 + 4.43 × 0.579) × $33.4009 = $959.00
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.
33267 billing questions
When should 33267 be used instead of 33268?
Use 33267 for open LAA exclusion performed as a standalone service. Use 33268 when open LAA exclusion is performed during another cardiac procedure.
How does 33267 differ from 33269?
33267 describes an open approach. 33269 is for thoracoscopic LAA exclusion.
Can the LAA exclusion be reported with another cardiac procedure?
If open LAA exclusion is performed during another cardiac procedure, report the applicable add-on code, 33268, rather than 33267. Document the procedures and the operative approach.
What documentation supports reporting 33267?
The operative report should establish the open approach, the left atrial appendage treated, the exclusion method, and whether the service was standalone or performed during another cardiac procedure.
Can modifier 50 be reported, and can an assistant be paid?
Modifier 50 is inappropriate based on the descriptor and anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.
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.
3,88733264,,Rmvl & rplcmt dfb gen mlt ld,A,,6.19,2.99,NA,2.99,,1.46,10.64,10.64,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,88833265,,Ablate atria lmtd endo,A,,23.12,9.94,NA,9.94,,5.69,38.75,38.75,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,88933266,,Ablate atria x10sv endo,A,,32.21,11.93,NA,11.93,,7.98,52.12,52.12,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,89033267,,Excl laa open any method,A,,18.04,7.13,NA,7.13,,4.43,29.60,29.60,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,89133268,,Excl laa opn oth px any meth,A,,2.44,0.48,NA,0.48,,0.59,3.51,3.51,0,ZZZ,0.00,0.00,0.00,0,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,89233269,,Excl laa thrscp any method,A,,13.95,6.42,NA,6.42,,3.46,23.83,23.83,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,89333270,,Ins/rep subq defibrillator,A,,8.87,3.81,NA,3.81,,2.08,14.76,14.76,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,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