Billing code 33990: VAD insertionMedicare rate & RVUs in Texas
Reports percutaneous placement of a temporary left-heart assist device through arterial access, such as for cardiogenic shock or support during high-risk PCI.
CMS doesn’t publish an office rate for 33990 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 33990 covers
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.
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 33990 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 | $310.02 |
| Beaumont | Unavailable | $305.55 |
| Brazoria | Unavailable | $303.10 |
| Dallas | Unavailable | $307.52 |
| Fort Worth | Unavailable | $307.76 |
| Galveston | Unavailable | $305.64 |
| Houston | Unavailable | $333.64 |
| Rest Of Texas | Unavailable | $305.86 |
How the 33990 rate is calculated
Each of 33990’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 · 33990
RVUs × geographic indexes × conversion factor
Work6.58
6.58 RVUs× 1.000 GPCI
Practice expense1.26
1.26 RVUs× 1.000 GPCI
Malpractice1.53
1.53 RVUs× 1.000 GPCI
Adjusted RVUs
9.3700
Conversion factor
$33.4009
Medicare rate
$312.97
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33990
The CMS indicators that decide how 33990 is paid alongside other services.
CMS payment indicators · 33990
VAD insertion
| 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
33990 without 51 · national facility
$312.97
VAD insertion
33990-51 · Second procedure: 50%
$156.49
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%).
33990 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33991VAD insertion
- 33990 is for arterial access only. Choose 33991 when both arterial and venous access are used for the left-heart device insertion.
- 33995VAD insertion
- 33995 describes percutaneous right-heart assist-device insertion through venous access; 33990 is for left-heart support through arterial access.
- 33992VAD removal
- 33992 describes removal of a percutaneous left-heart assist device, not its insertion.
- 33988Left heart vent
- 33988 describes insertion of a left-heart vent by a surgical approach; 33990 is percutaneous assist-device insertion through arterial access.
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 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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