Billing code 33681: VSD closureMedicare rate & RVUs in Ohio
Open cardiac surgery to close one ventricular septal defect, using direct closure or a patch, when no separately specified added maneuver changes code selection.
CMS doesn’t publish an office rate for 33681 in Ohio.
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 33681 covers
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.
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 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $1,710.82 |
How the 33681 rate is calculated
Each of 33681’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 · 33681
RVUs × geographic indexes × conversion factor
Work31.53
31.53 RVUs× 1.000 GPCI
Practice expense12.79
12.79 RVUs× 1.000 GPCI
Malpractice7.95
7.95 RVUs× 1.000 GPCI
Adjusted RVUs
52.2700
Conversion factor
$33.4009
Medicare rate
$1,745.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33681
33681 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33681
VSD closure
| 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 · 33681
VSD closure
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
33681 without 51 · national facility
$1,745.87
VSD closure
33681-51 · Second procedure: 50%
$872.94
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%).
33681 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33675VSD closure
- 33681 is for closing one ventricular septal defect. Use 33675 for closure of multiple defects when its descriptor fits the operative work.
- 33684VSD closure
- 33684 describes single-defect closure combined with pulmonary valvotomy or infundibular resection; 33681 covers closure without that specified added work.
- 33688VSD closure
- Choose 33688 when single-defect closure is performed with removal of a pulmonary artery band; 33681 does not capture that combination.
- 33641ASD repair
- 33641 concerns repair of an atrial septal defect. Use 33681 for a ventricular septal defect.
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 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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