Billing code 33764: Systemic-pulmonary shuntMedicare rate & RVUs in Texas
Reports creation of a central systemic-to-pulmonary artery shunt using a prosthetic graft, typically to increase pulmonary blood flow in congenital heart disease.
CMS doesn’t publish an office rate for 33764 in Texas.
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 33764 covers
A congenital cardiac surgeon creates a central connection from the systemic arterial circulation to the pulmonary artery using a prosthetic graft. The shunt provides additional pulmonary blood flow, often as palliation for a cyanotic congenital heart defect with inadequate flow to the lungs. The procedure is performed in an operating room; the operative report should identify the shunt’s origin and insertion and confirm use of a prosthetic graft.
Select this code for the central graft configuration, rather than choosing by the general goal of increasing pulmonary blood flow alone. Document the anatomy and construction so the central route can be distinguished from named subclavian or aortic shunt routes. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeons require 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 33764 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $1,262.32 |
| Beaumont | Unavailable | $1,218.40 |
| Brazoria | Unavailable | $1,224.26 |
| Dallas | Unavailable | $1,241.16 |
| Fort Worth | Unavailable | $1,240.16 |
| Galveston | Unavailable | $1,233.84 |
| Houston | Unavailable | $1,335.43 |
| Rest Of Texas | Unavailable | $1,226.86 |
How the 33764 rate is calculated
Each of 33764’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 · 33764
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 22.04Practice expense 10.20Malpractice 5.55
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 33764
33764 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33764
Systemic-pulmonary shunt
| 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 · 33764
Systemic-pulmonary shunt
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
33764 without 51 · national facility
$1,262.22
Systemic-pulmonary shunt
33764-51 · Second procedure: 50%
$631.11
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%).
33764 compared with similar codes
Compare codes
33764 vs 33750 vs 33755 vs 33762 vs 33766: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 33750Systemic-to-pulmonary shunt
- Use 33750 when the shunt originates from the subclavian artery. This code describes a central prosthetic-graft configuration.
- 33755Systemic-pulmonary shunt
- 33755 identifies an ascending aorta-to-pulmonary artery shunt. Choose this code for the central graft configuration rather than that named route.
- 33762Systemic-to-pulmonary shunt
- 33762 identifies a descending aorta-to-pulmonary artery shunt. The central prosthetic-graft configuration is reported with this code.
- 33766Glenn shunt
- 33766 is a superior vena cava-to-pulmonary artery shunt for one lung, not a systemic arterial-to-pulmonary artery graft shunt.
33764 billing questions
How is this distinguished from a subclavian-to-pulmonary artery shunt?
This code is for the central shunt configuration using a prosthetic graft. A shunt originating from the subclavian artery is reported with 33750.
What operative details support code selection?
The report should establish the central route, identify the systemic arterial origin and pulmonary artery insertion, and document the prosthetic graft.
Can modifier 50 be used for a bilateral shunt?
No. CMS identifies bilateral adjustment as inappropriate for this code.
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.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeons are paid only with 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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