Billing code 33500: Coronary fistula repairMedicare rate & RVUs in Virginia
Reports operative repair of a coronary arteriovenous fistula when the surgeon performs the repair without cardiopulmonary bypass.
CMS doesn’t publish an office rate for 33500 in Virginia.
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 33500 covers
A cardiothoracic surgeon uses this code to surgically close or repair an abnormal connection involving a coronary artery, such as a coronary artery draining into a cardiac chamber or vessel. The repair is performed without cardiopulmonary bypass. It is typically an operating-room service in a hospital facility, rather than an office procedure.
Select the code when the operative report documents repair of a coronary arteriovenous fistula and confirms that cardiopulmonary bypass was not used; the bypass method distinguishes it from 33501. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Bilateral adjustment is inappropriate for this anatomy. An assistant at surgery may be paid; co-surgeon payment requires 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 33500 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $1,625.88 |
| Virginia | Unavailable | $1,417.77 |
How the 33500 rate is calculated
Each of 33500’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 · 33500
RVUs × geographic indexes × conversion factor
Work27.24
27.24 RVUs× 1.000 GPCI
Practice expense10.78
10.78 RVUs× 1.000 GPCI
Malpractice6.53
6.53 RVUs× 1.000 GPCI
Adjusted RVUs
44.5500
Conversion factor
$33.4009
Medicare rate
$1,488.01
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33500
33500 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33500
Coronary fistula repair
| 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 · 33500
Coronary fistula repair
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
33500 without 51 · national facility
$1,488.01
Coronary fistula repair
33500-51 · Second procedure: 50%
$744.01
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%).
33500 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33501Coronary fistula repair
- This is the direct counterpart for coronary arteriovenous fistula repair performed with cardiopulmonary bypass. Code 33500 is for repair without bypass.
- 33502Coronary repair
- This addresses correction of an anomalous coronary artery origin, not repair of a coronary arteriovenous fistula.
- 33503Coronary repair
- This addresses a coronary artery graft procedure, rather than closure or repair of a coronary arteriovenous fistula.
33500 billing questions
How is 33500 distinguished from 33501?
Both describe repair of a coronary arteriovenous fistula. Use 33500 when the repair is performed without cardiopulmonary bypass; 33501 is the bypass counterpart.
What documentation supports reporting 33500?
The operative report should identify the coronary arteriovenous fistula, describe its surgical repair, and establish that cardiopulmonary bypass was not used.
Does the 90-day global period include related postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Should modifier 50 be used for a fistula on each side?
No. CMS identifies bilateral adjustment as inappropriate for this code's descriptor or anatomy.
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
Fee sheets
Put 33500 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →