Billing code 33697: Tetralogy repairMedicare rate & RVUs in Massachusetts
Reports definitive surgical correction of tetralogy of Fallot when pulmonary atresia is present, including repair of the associated intracardiac and pulmonary outflow abnormalities.
CMS doesn’t publish an office rate for 33697 in Massachusetts.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 33697 covers
This code represents definitive surgical correction of tetralogy of Fallot with pulmonary atresia. A congenital cardiac surgeon typically performs the open-heart operation in a hospital operating room. The repair addresses the intracardiac defect and establishes or reconstructs a pathway for blood to reach the pulmonary arteries; the exact reconstruction depends on the patient’s anatomy. It is distinct from a staged palliative operation that does not complete the repair.
Select the code from the documented diagnosis and operative report, especially whether pulmonary atresia is present and what definitive repair was performed. The comprehensive service includes maneuvers integral to that repair; do not separately report those steps as independent procedures. 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 other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
Where 33697 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | Unavailable | $2,000.56 |
| Rest Of Massachusetts | Unavailable | $1,887.86 |
How the 33697 rate is calculated
Each of 33697’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 33697
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 36.63Practice expense 11.34Malpractice 9.24
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 33697
33697 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33697
Tetralogy repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 33697
Tetralogy repair
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33697 without 51 · national facility
$1,910.87
Tetralogy repair
33697-51 · Second procedure: 50%
$955.44
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
33697 compared with similar codes
Compare codes
33697 vs 33692 vs 33694 vs 33690 vs 33622: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 33692Tetralogy repair
- Choose 33692 for complete tetralogy repair when pulmonary atresia is absent. Pulmonary atresia is the key distinction from this code.
- 33694Tetralogy repair
- Choose 33694 for tetralogy repair without pulmonary atresia when pulmonary artery reconstruction is included. This code is for the repair with pulmonary atresia.
- 33690Pulmonary artery banding
- Code 33690 describes pulmonary artery banding, a palliative operation. This code describes definitive correction of tetralogy of Fallot with pulmonary atresia.
- 33622Congenital heart surgery
- Code 33622 is for a redo operation for a complex cardiac anomaly. This code describes definitive tetralogy repair with pulmonary atresia, rather than a redo-specific service.
33697 billing questions
How does this differ from codes 33692 and 33694?
This code is for tetralogy of Fallot with pulmonary atresia. Codes 33692 and 33694 describe repair when pulmonary atresia is absent, with 33694 distinguishing a repair that includes pulmonary artery reconstruction.
Can a staged palliative operation be reported with this code?
Use this code for definitive correction, not for a separate operation that only provides palliation. The operative report should support that the surgeon completed the repair.
Are the repair’s component maneuvers separately reportable?
Maneuvers integral to the comprehensive repair are included in the service. Review the operative report to distinguish integral steps from any separately performed, distinct procedure.
Can modifier 50 be used?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How are assistant and co-surgeon claims handled?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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