33991 VAD insertion Medicare reimbursement rates in Hawaii

This service places a percutaneous ventricular assist device to support left-heart circulation, commonly for a patient with cardiogenic shock or during a high-risk cardiac intervention. A cardiologist, interventional cardiologist, or cardiac surgeon typically performs the procedure in a hospital catheterization laboratory or operating room. The distinguishing feature is use of both arterial and venous access; the related arterial-only insertion code is not interchangeable when the documented procedure requires both routes. The code includes radiological supervision and interpretation for device placement.

Report the code when the operative or catheterization report supports percutaneous left-heart device insertion and documents both access routes. The record should identify the indication, device, chamber supported, and access used. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeons and team surgery are not permitted. Modifier 50 is inappropriate.