No office rate
33681 is for closing one ventricular septal defect. Use 33675 for closure of multiple defects when its descriptor fits the operative work.
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CMS RVU26D · Effective 2026-10-01
33681 VSD closure Medicare reimbursement rates in Iowa
Open cardiac surgery to close one ventricular septal defect, using direct closure or a patch, when no separately specified added maneuver changes code selection. Compare 33681 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 33681 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
$1549.43
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.
Congenital cardiac surgery
About 33681: Single ventricular septal defect closure
Open cardiac surgery to close one ventricular septal defect, using direct closure or a patch, when no separately specified added maneuver changes code selection.
A congenital cardiac surgeon uses this code for operative closure of a single opening between the heart’s ventricles. The surgeon may close the defect directly or use a patch; the code covers either method. This is typically an operating-room procedure for a patient with a ventricular septal defect requiring surgical repair, rather than catheter-based device closure. The operative report should establish that one defect was closed and describe the repair performed.
Select this code by the number of defects repaired and the operative work: closure of multiple defects, or closure combined with a specifically described maneuver such as pulmonary valvotomy or removal of a pulmonary artery band, may point to a different code. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation. Team surgery is not permitted.
CMS billing rules for 33681
- 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 RVU31.53 · 60%
- Practice expense (office) RVU12.79 · 24%
- Malpractice RVU7.95 · 15%
180
Medicare services in 2024 · #4421 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.
33681 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
33684 describes single-defect closure combined with pulmonary valvotomy or infundibular resection; 33681 covers closure without that specified added work.
No office rate
Choose 33688 when single-defect closure is performed with removal of a pulmonary artery band; 33681 does not capture that combination.
No office rate
33641 concerns repair of an atrial septal defect. Use 33681 for a ventricular septal defect.
Compare 33681 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
$1549.43
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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 33681 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
4,030
- Code
- 33681
- Physician work
- 31.53
- Practice expense
- 12.79
- Malpractice
- 7.95
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 31.53 | × 1.000 | 31.5300 |
| Practice expense | 12.79 | × 0.915 | 11.7028 |
| Malpractice | 7.95 | × 0.397 | 3.1562 |
| Total RVUs | 46.3890 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$1549.43
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 31.53 | 1 |
| Practice expense | 12.79 | 0.915 |
| Malpractice | 7.95 | 0.397 |
(31.53 × 1 + 12.79 × 0.915 + 7.95 × 0.397) × $33.4009 = $1549.43
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.
33681 billing questions
When is 33681 selected instead of a multiple-defect closure code?
Use 33681 when the operation closes one ventricular septal defect. Closure of multiple defects is represented by a different code, with the exact choice depending on additional operative work.
Does using a patch change the code?
No. This code covers closure of one defect whether the surgeon closes it directly or uses a patch.
How should a closure with pulmonary valvotomy be coded?
Check the code for single-defect closure that includes pulmonary valvotomy or infundibular resection, 33684, rather than defaulting to 33681.
Is removal of a pulmonary artery band included in 33681?
A closure performed with removal of a pulmonary artery band is described by 33688. The operative report should document whether that band-removal work was performed.
What documentation supports 33681?
Document that one ventricular septal defect was repaired and describe whether the closure was direct or used a patch. Record any additional cardiac procedure or maneuver that could change code selection.
How does the global period affect postoperative billing?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
4,02733675,,Close mult vsd,A,,35.05,11.06,NA,11.06,,8.84,54.95,54.95,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,02833676,,Close mult vsd w/resection,A,,36.03,11.24,NA,11.24,,9.09,56.36,56.36,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,02933677,,Cl mult vsd w/rem pul band,A,,37.49,11.53,NA,11.53,,9.44,58.46,58.46,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,03033681,,Closure 1 vsd w/wo patch,A,,31.53,12.79,NA,12.79,,7.95,52.27,52.27,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,03133684,,Clsr 1 vsd w/wo patch w/vlvt,A,,33.51,10.73,NA,10.73,,8.46,52.70,52.70,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,03233688,,Clsr 1vsd w/wo ptch rmvl bnd,A,,33.88,9.74,NA,9.74,,8.55,52.17,52.17,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,03333690,,Banding pulmonary artery,A,,19.85,9.76,NA,9.76,,4.99,34.60,34.60,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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