No office rate
33990 is for arterial access only. Choose 33991 when both arterial and venous access are used for the left-heart device insertion.
On this page
CMS RVU26D · Effective 2026-10-01
33990 VAD insertion Medicare reimbursement rates in Rhode Island
Reports percutaneous placement of a temporary left-heart assist device through arterial access, such as for cardiogenic shock or support during high-risk PCI. Compare 33990 office and facility rates across CMS payment localities in Rhode Island.
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 33990 in Rhode Island?
Rhode Island 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
$313.01
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Cardiac surgery
About 33990: Percutaneous left ventricular assist device insertion
Reports percutaneous placement of a temporary left-heart assist device through arterial access, such as for cardiogenic shock or support during high-risk PCI.
This service places a temporary percutaneous ventricular assist device in the left heart through arterial access, commonly the femoral artery, with the device positioned to support systemic circulation. Interventional cardiologists and cardiac surgeons perform it in a catheterization laboratory or other hospital setting, often for cardiogenic shock or hemodynamic support during high-risk percutaneous coronary intervention. Imaging supervision and interpretation for device placement are part of the service.
Report 33990 when the left-heart device is inserted using arterial access only; documentation should establish the access route, device placement, clinical indication, and imaging used to guide placement. The code has a 0-day global period, so same-day preoperative and postoperative care is included. 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% multiple-procedure reduction. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.
CMS billing rules for 33990
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.58 · 70%
- Practice expense (office) RVU1.26 · 13%
- Malpractice RVU1.53 · 16%
7.9K
Medicare services in 2024 · #1597 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.
33990 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
33995 describes percutaneous right-heart assist-device insertion through venous access; 33990 is for left-heart support through arterial access.
No office rate
33992 describes removal of a percutaneous left-heart assist device, not its insertion.
No office rate
33988 describes insertion of a left-heart vent by a surgical approach; 33990 is percutaneous assist-device insertion through arterial access.
Compare 33990 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
Rhode Island →
Office / nonfacility
Unavailable
Facility
$313.01
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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 33990 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
4,174
- Code
- 33990
- Physician work
- 6.58
- Practice expense
- 1.26
- Malpractice
- 1.53
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.58 | × 1.019 | 6.7050 |
| Practice expense | 1.26 | × 1.033 | 1.3016 |
| Malpractice | 1.53 | × 0.892 | 1.3648 |
| Total RVUs | 9.3714 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$313.01
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.58 | 1.019 |
| Practice expense | 1.26 | 1.033 |
| Malpractice | 1.53 | 0.892 |
(6.58 × 1.019 + 1.26 × 1.033 + 1.53 × 0.892) × $33.4009 = $313.01
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.
33990 billing questions
How does 33990 differ from 33991?
Use 33990 for left-heart device insertion with arterial access only. Use 33991 when insertion requires both arterial and venous access.
Is imaging reported separately?
Imaging supervision and interpretation for device placement are included in this service.
What documentation supports 33990?
Document the indication, arterial access, device placement in the left heart, and imaging used to guide the procedure.
Can an assistant surgeon be reported?
Assistant-at-surgery payment may be made for this code. Co-surgeons and team surgery are not permitted.
How does the 0-day global affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
How is 33990 affected when other procedures occur in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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.
4,17133987,,Artery expos/graft artery,A,,3.94,0.81,NA,0.81,,0.95,5.70,5.70,0,ZZZ,0.00,0.00,0.00,0,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17233988,,Insertion of left heart vent,A,,14.63,3.16,NA,3.16,,3.49,21.28,21.28,0,000,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17333989,,Removal of left heart vent,A,,9.26,2.05,NA,2.05,,2.21,13.52,13.52,0,000,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17433990,,Insj perq vad l hrt arterial,A,,6.58,1.26,NA,1.26,,1.53,9.37,9.37,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17533991,,Insj perq vad l hrt artl&ven,A,,8.62,1.77,NA,1.77,,2.06,12.45,12.45,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17633992,,Rmvl perq left heart vad,A,,3.46,0.66,NA,0.66,,0.82,4.94,4.94,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,17733993,,Reposg perq r/l hrt vad,A,,3.02,0.66,NA,0.66,,0.58,4.26,4.26,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537