No office rate
Both codes report ECMO/ECLS initiation in patients age six and older. Choose 33946 for venovenous support and 33947 for venoarterial support.
On this page
CMS RVU26D · Effective 2026-10-01
33946 ECMO initiation Medicare reimbursement rates in Kentucky
Reports physician work to initiate venovenous ECMO/ECLS in patients age six and older when respiratory support is needed through extracorporeal gas exchange. Compare 33946 office and facility rates across CMS payment localities in Kentucky.
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 33946 in Kentucky?
Kentucky 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
$271.32
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Critical care
About 33946: Venovenous ECMO initiation
Reports physician work to initiate venovenous ECMO/ECLS in patients age six and older when respiratory support is needed through extracorporeal gas exchange.
This service covers starting venovenous extracorporeal membrane oxygenation or extracorporeal life support in a patient age six or older. Venous blood is routed through an extracorporeal circuit for gas exchange and returned to the venous circulation, supporting patients with severe respiratory failure when conventional respiratory support is inadequate. The physician directing initiation may be a critical care specialist, cardiothoracic surgeon, or another clinician experienced in ECMO, typically in an intensive care setting.
Report 33946 for the initiation phase, not for ongoing daily ECMO management or an arterial-return configuration. The record should establish the patient’s age, the venovenous support configuration, the clinical need for ECMO, and the physician’s work initiating the service. Cannula insertion has separate codes in the ECMO/ECLS code family when that work is performed. CMS lists no special payment rules for this code in the supplied facts.
Where the value comes from
- Work RVU5.85 · 70%
- Practice expense (office) RVU1.26 · 15%
- Malpractice RVU1.26 · 15%
597
Medicare services in 2024 · #3398 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.
33946 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
This code reports daily management of venovenous ECMO/ECLS after initiation; 33946 reports starting the support.
No office rate
This code reports daily management of venoarterial ECMO/ECLS, rather than venovenous initiation.
No office rate
This code represents peripheral cannula insertion, not initiation of the venovenous ECMO/ECLS service.
Compare 33946 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$271.32
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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 33946 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
4,132
- Code
- 33946
- Physician work
- 5.85
- Practice expense
- 1.26
- Malpractice
- 1.26
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.85 | × 1.000 | 5.8500 |
| Practice expense | 1.26 | × 0.889 | 1.1201 |
| Malpractice | 1.26 | × 0.915 | 1.1529 |
| Total RVUs | 8.1230 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$271.32
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.85 | 1 |
| Practice expense | 1.26 | 0.889 |
| Malpractice | 1.26 | 0.915 |
(5.85 × 1 + 1.26 × 0.889 + 1.26 × 0.915) × $33.4009 = $271.32
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.
33946 billing questions
When is 33946 chosen instead of 33947?
Use 33946 for venovenous support, with blood returned to the venous circulation. Code 33947 describes initiation of a venoarterial configuration.
Can 33946 be used for daily ECMO management?
No. It represents initiation; 33948 describes daily management of venovenous ECMO/ECLS.
Does 33946 include cannula insertion?
Cannula insertion is represented by separate codes in the ECMO/ECLS family when that work is performed. Document the insertion separately from the physician’s initiation work.
What age range does 33946 cover?
This initiation code applies to patients age six and older. Check the applicable age-specific code when the patient is younger.
What documentation supports reporting 33946?
Document the respiratory indication, venovenous circuit configuration, initiation work, and patient age. The record should distinguish initiation from subsequent daily management.
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.
4,12933940,,Removal of donor heart,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,13033944,,Prepare donor heart,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,13133945,,Transplantation of heart,R,,87.26,26.39,NA,26.39,,21.58,135.23,135.23,0,090,0.09,0.84,0.07,2,0,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
4,13233946,,Ecmo/ecls initiation venous,A,,5.85,1.26,NA,1.26,,1.26,8.37,8.37,0,XXX,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,13333947,,Ecmo/ecls initiation artery,A,,6.46,1.36,NA,1.36,,1.41,9.23,9.23,0,XXX,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,13433948,,Ecmo/ecls daily mgmt-venous,A,,4.61,1.08,NA,1.08,,0.81,6.50,6.50,0,XXX,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,13533949,,Ecmo/ecls daily mgmt artery,A,,4.49,1.02,NA,1.02,,0.75,6.26,6.26,0,XXX,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631