No office rate
93656 reports catheter ablation directed at atrial fibrillation. Use 33340 for placement of an implant to close the left atrial appendage; both services may be performed in one session.
On this page
CMS RVU26D · Effective 2026-10-01
33340 Appendage closure Medicare reimbursement rates in Hawaii
Reports catheter-based placement of an implant to close the left atrial appendage, commonly for stroke-risk reduction in patients with atrial fibrillation. Compare 33340 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 33340 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
$613.82
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.
Cardiology procedure
About 33340: Percutaneous left atrial appendage closure
Reports catheter-based placement of an implant to close the left atrial appendage, commonly for stroke-risk reduction in patients with atrial fibrillation.
An interventional cardiologist or electrophysiologist advances a catheter through a transseptal route and places an endocardial implant to close the left atrial appendage. The procedure is generally performed in a hospital catheterization or electrophysiology lab with imaging guidance. It is used for selected patients with atrial fibrillation when a strategy to reduce embolic stroke risk is being pursued; the record should identify the indication, implant placement, and procedural findings.
Report 33340 for the transcatheter closure procedure, including its transseptal access and integral fluoroscopic and angiographic guidance. The code has a 0-day global period, so same-day preoperative and postoperative care is included. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment requires documented medical necessity; co-surgeons are permitted, and team-surgery payment requires supporting documentation.
CMS billing rules for 33340
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery paid only with supporting documentation.
Where the value comes from
- Work RVU9.99 · 54%
- Practice expense (office) RVU6.18 · 33%
- Malpractice RVU2.35 · 13%
60.1K
Medicare services in 2024 · #712 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.
33340 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
33361 reports transcatheter replacement of the aortic valve. It treats a different cardiac structure and is not the code for left atrial appendage closure.
Compare 33340 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
$613.82
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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 33340 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,922
- Code
- 33340
- Physician work
- 9.99
- Practice expense
- 6.18
- Malpractice
- 2.35
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.99 | × 1.000 | 9.9900 |
| Practice expense | 6.18 | × 1.137 | 7.0267 |
| Malpractice | 2.35 | × 0.579 | 1.3606 |
| Total RVUs | 18.3773 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$613.82
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.99 | 1 |
| Practice expense | 6.18 | 1.137 |
| Malpractice | 2.35 | 0.579 |
(9.99 × 1 + 6.18 × 1.137 + 2.35 × 0.579) × $33.4009 = $613.82
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.
33340 billing questions
When should 33340 be reported instead of an atrial fibrillation ablation code?
Report 33340 for catheter-based implant closure of the left atrial appendage. Atrial fibrillation ablation treats the arrhythmia itself; appendage closure is intended to reduce embolic stroke risk.
Does 33340 include transseptal access and fluoroscopic guidance?
Yes. The closure service includes the transseptal catheter access and integral fluoroscopic and angiographic guidance used for implant placement.
Can an assistant surgeon be billed for this procedure?
Assistant-at-surgery payment is allowed only when the record supports medical necessity. Co-surgeons are permitted, while team-surgery payment requires supporting documentation.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure. The code has no postoperative global days beyond the date of service.
How is 33340 paid when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and the other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this 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 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.
3,91933322,,Repair major blood vessel(s),A,,23.81,10.03,NA,10.03,,5.93,39.77,39.77,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92033330,,Insert major vessel graft,A,,24.66,10.25,NA,10.25,,5.91,40.82,40.82,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92133335,,Insert major vessel graft,A,,33.06,11.97,NA,11.97,,7.93,52.96,52.96,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92233340,,Perq clsr tcat l atr apndge,A,,9.99,6.18,NA,6.18,,2.35,18.52,18.52,0,000,0.00,0.00,0.00,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92333361,,Replace aortic valve perq,A,,21.91,5.14,NA,5.14,,5.26,32.31,32.31,0,000,0.00,0.00,0.00,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92433362,,Replace aortic valve open,A,,23.93,5.48,NA,5.48,,5.78,35.19,35.19,0,000,0.00,0.00,0.00,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,92533363,,Replace aortic valve open,A,,24.83,5.71,NA,5.71,,6.02,36.56,36.56,0,000,0.00,0.00,0.00,2,0,0,2,1,9,,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