No office rate
This code addresses thrombus involving a prosthetic valve that is repaired and retained. Code 33413 is for aortic valve replacement, not clot-directed repair.
On this page
CMS RVU26D · Effective 2026-10-01
33496 Valve thrombus repair Medicare reimbursement rates in Maine
Open cardiac surgery with cardiopulmonary bypass to clear thrombus affecting an existing prosthetic heart valve when the valve is repaired rather than replaced. Compare 33496 office and facility rates across CMS payment localities in Maine.
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 33496 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1467.87–$1497.08
2 of 2 localities have a supported rate.
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 33496: Thrombus repair of prosthetic heart valve
Open cardiac surgery with cardiopulmonary bypass to clear thrombus affecting an existing prosthetic heart valve when the valve is repaired rather than replaced.
A cardiac surgeon uses cardiopulmonary bypass to address thrombus obstructing or impairing an implanted prosthetic heart valve. The operation treats the clot-related problem while retaining and repairing the prosthesis, rather than removing it for valve replacement. It is a facility-based cardiac surgery service, not a separately reported diagnostic or catheter-based clot treatment.
Report the code when the operative work addresses thrombus involving a prosthetic valve. The operative report should identify the affected valve, document the thrombus and the repair performed, and clarify whether the prosthesis was retained or replaced. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures 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 33496
- 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 RVU29.09 · 61%
- Practice expense (office) RVU11.43 · 24%
- Malpractice RVU6.98 · 15%
23
Medicare services in 2024 · #5843 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.
33496 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
Use this code for thrombus-related repair of a retained prosthetic valve. Code 33430 applies when the mitral valve is replaced.
No office rate
Code 33414 concerns aortic valve repair; this code is specific to thrombus involving an existing prosthetic heart valve.
Compare 33496 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$1467.87
Southern Maine →
Office / nonfacility
Unavailable
Facility
$1497.08
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33496 billing questions
How is this code distinguished from a valve replacement code?
Use this code when surgery treats thrombus affecting a prosthetic valve and the valve is retained and repaired. If the surgeon removes the prosthesis and implants a replacement, select the applicable replacement code instead.
Does this code include replacement of the prosthetic valve?
No. It describes repair directed at the thrombus problem with the prosthesis retained; replacement is a different operative service.
What documentation supports reporting this service?
The operative report should identify the prosthetic valve involved, describe the thrombus and the repair, and make clear whether the prosthesis was retained or replaced.
How does the 90-day global period affect postoperative reporting?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation.
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.
3,96833476,,Revision of heart chamber,A,,25.91,10.93,NA,10.93,,6.53,43.37,43.37,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96933477,,Implant tcat pulm vlv perq,A,,24.38,5.11,NA,5.11,,4.23,33.72,33.72,0,000,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97033478,,Revision of heart chamber,A,,26.85,11.11,NA,11.11,,6.75,44.71,44.71,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97133496,,Repair prosth valve clot,A,,29.09,11.43,NA,11.43,,6.98,47.50,47.50,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97233500,,Repair heart vessel fistula,A,,27.24,10.78,NA,10.78,,6.53,44.55,44.55,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97333501,,Repair heart vessel fistula,A,,19.02,8.62,NA,8.62,,4.55,32.19,32.19,0,090,0.09,0.84,0.07,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97433502,,Coronary artery correction,A,,21.30,10.02,NA,10.02,,5.36,36.68,36.68,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00