Billing code 33993: VAD repositioningMedicare rate & RVUs in Ohio
Reports image-guided catheter repositioning of an existing percutaneous right- or left-heart ventricular assist device when its position must be adjusted to maintain support.
CMS doesn’t publish an office rate for 33993 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 33993 covers
This service adjusts the position of an already placed percutaneous ventricular assist device in the right or left heart, using imaging guidance to direct and confirm the repositioning. It is typically performed by an interventional cardiologist in a catheterization laboratory or another setting where temporary mechanical circulatory support is managed. The work is distinct from placing a new device or removing one that is no longer needed.
Report the code when the record supports a separate repositioning service, including the device involved, why its position required adjustment, and how imaging was used to guide the work. Imaging guidance and its associated supervision and interpretation are included. The service has a 0-day global period, so same-day preoperative and postoperative care is included. 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 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeons and team surgery are 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.
33993 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $140.52 |
How the 33993 rate is calculated
Each of 33993’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 · 33993
RVUs × geographic indexes × conversion factor
Work3.02
3.02 RVUs× 1.000 GPCI
Practice expense0.66
0.66 RVUs× 1.000 GPCI
Malpractice0.58
0.58 RVUs× 1.000 GPCI
Adjusted RVUs
4.2600
Conversion factor
$33.4009
Medicare rate
$142.29
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33993
The CMS indicators that decide how 33993 is paid alongside other services.
CMS payment indicators · 33993
VAD repositioning
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33993 without 51 · national facility
$142.29
VAD repositioning
33993-51 · Second procedure: 50%
$71.15
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%).
33993 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33990VAD insertion
- 33990 reports percutaneous placement of a left-heart VAD by an arterial approach. This code is for repositioning an existing device.
- 33991VAD insertion
- 33991 reports percutaneous left-heart VAD placement using arterial and venous approaches; it is not the code for subsequent position adjustment.
- 33995VAD insertion
- 33995 reports percutaneous right-heart VAD placement. Choose this code when an existing percutaneous right- or left-heart VAD is repositioned instead.
- 33992VAD removal
- 33992 reports percutaneous removal of a left-heart VAD. Repositioning applies when the device remains in place and its position is adjusted.
33993 billing questions
When should this code be used instead of an insertion code?
Use it for adjusting the position of a percutaneous ventricular assist device that is already in place. Report an insertion code when the service places the device rather than repositioning it.
Is imaging guidance separately reported?
No. Imaging guidance, including the associated supervision and interpretation, is part of the repositioning service.
Can modifier 50 be used for repositioning on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How does the multiple-procedure reduction affect payment?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are paid at 50%.
Can an assistant-at-surgery be reported?
Assistant-at-surgery payment may be made. Co-surgeons and team surgery are not permitted.
What documentation supports reporting repositioning?
Document the device and heart side, the reason its position needed adjustment, the repositioning performed, and the imaging used to guide the work.
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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