No office rate
Both describe open LAA exclusion. Choose 33268 when it is performed during another cardiac procedure; 33267 describes the open exclusion outside that circumstance.
On this page
CMS RVU26D · Effective 2026-10-01
33268 LAA exclusion Medicare reimbursement rates in Iowa
Report this add-on when a surgeon excludes the left atrial appendage during an open cardiac operation, such as eligible bypass or valve surgery. Compare 33268 office and facility rates across CMS payment localities in Iowa.
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 33268 in Iowa?
Iowa 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
$103.99
1 of 1 localities have a supported rate.
Payment area: Iowa
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 33268: Open left atrial appendage exclusion during cardiac surgery
Report this add-on when a surgeon excludes the left atrial appendage during an open cardiac operation, such as eligible bypass or valve surgery.
During an open cardiac operation, the cardiac surgeon excludes the left atrial appendage from the circulation using a surgical method such as excision, suture closure, or stapling. The appendage is a pouch on the left atrium; exclusion is commonly performed for a patient with atrial fibrillation who is already having surgery such as coronary artery bypass grafting or valve surgery. This service addresses the appendage, rather than ablating atrial tissue to treat an arrhythmia.
Report 33268 as an add-on to the eligible primary cardiac procedure, not by itself. The operative report should identify the appendage exclusion, the method used, and the concurrent cardiac operation supporting the primary code. CMS payment for this add-on falls within the primary procedure's global period. Examples of concurrent operations include eligible CABG and valve procedures.
CMS billing rules for 33268
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU2.44 · 70%
- Practice expense (office) RVU0.48 · 14%
- Malpractice RVU0.59 · 17%
16.3K
Medicare services in 2024 · #1223 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.
33268 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
Both address LAA exclusion, but 33269 is for the thoracoscopic approach. Use 33268 for exclusion during another open cardiac procedure.
No office rate
33259 describes surgical atrial ablation associated with another cardiac procedure; 33268 describes exclusion of the left atrial appendage.
Compare 33268 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
Iowa →
Office / nonfacility
Unavailable
Facility
$103.99
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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 33268 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
3,891
- Code
- 33268
- Physician work
- 2.44
- Practice expense
- 0.48
- Malpractice
- 0.59
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.44 | × 1.000 | 2.4400 |
| Practice expense | 0.48 | × 0.915 | 0.4392 |
| Malpractice | 0.59 | × 0.397 | 0.2342 |
| Total RVUs | 3.1134 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$103.99
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.44 | 1 |
| Practice expense | 0.48 | 0.915 |
| Malpractice | 0.59 | 0.397 |
(2.44 × 1 + 0.48 × 0.915 + 0.59 × 0.397) × $33.4009 = $103.99
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.
33268 billing questions
When should 33268 be chosen instead of 33267?
Use 33268 when LAA exclusion is performed during another open cardiac procedure. Code 33267 describes open LAA exclusion outside that concurrent-procedure circumstance.
How does 33268 differ from 33269?
33268 is for LAA exclusion during another open cardiac procedure. Code 33269 is for thoracoscopic LAA exclusion.
Can 33268 be reported without a primary procedure?
No. It is an add-on and must be reported with an eligible primary cardiac procedure.
What documentation supports reporting 33268?
The operative report should describe the LAA exclusion and method, and identify the concurrent cardiac operation reported as the primary procedure.
Is 33268 the code for surgical atrial ablation?
No. It describes exclusion of the left atrial appendage. Surgical atrial ablation codes describe treatment directed at atrial arrhythmia tissue.
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.
3,88833265,,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
3,89433271,,Insj subq impltbl dfb elctrd,A,,7.31,3.10,NA,3.10,,1.75,12.16,12.16,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136