No office rate
This code is associated with repair of double-outlet ventricular anatomy. Use it when that specific repair is performed, rather than selecting based only on VSD enlargement.
On this page
CMS RVU26D · Effective 2026-10-01
33610 Congenital heart repair Medicare reimbursement rates in Virginia
Reports open congenital heart reconstruction in which the surgeon enlarges a ventricular septal defect to address the heart’s abnormal blood-flow pathway. Compare 33610 office and facility rates across CMS payment localities in Virginia.
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 33610 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1594.84–$1832.39
2 of 2 localities have a supported rate.
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 33610: Congenital heart repair with VSD enlargement
Reports open congenital heart reconstruction in which the surgeon enlarges a ventricular septal defect to address the heart’s abnormal blood-flow pathway.
This code describes open repair of a congenital cardiac defect that includes surgically enlarging a ventricular septal defect (VSD). The enlargement changes the pathway through the ventricles as part of the reconstruction; it is not simply closure of an isolated VSD. A congenital cardiac surgeon typically performs the operation in a hospital operating room, often with cardiopulmonary bypass. The operative report should identify the congenital anatomy and explain how enlargement of the VSD contributes to the repair.
Select the code from the operation actually performed, not from the diagnosis alone. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 33610
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU30.62 · 61%
- Practice expense (office) RVU11.88 · 24%
- Malpractice RVU7.72 · 15%
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.
33610 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
This is another double-outlet ventricular repair code. The operative technique and anatomy, not simply the presence of a VSD, distinguish it from 33610.
No office rate
33681 describes closure of a single VSD, with or without a patch. 33610 is for congenital reconstruction that enlarges the VSD.
No office rate
33608 describes repair of a congenital anomaly with a conduit. Choose it when the documented repair uses that approach rather than VSD enlargement.
Compare 33610 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$1832.39
Virginia →
Office / nonfacility
Unavailable
Facility
$1594.84
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33610 billing questions
How is this different from a code for VSD closure?
This code represents reconstruction that enlarges the VSD as part of the repair. A VSD-closure code describes closing a defect, with or without a patch, rather than enlarging it to alter the pathway.
What documentation supports reporting this code?
The operative report should describe the congenital anatomy, the VSD enlargement, and its role in the reconstruction. A diagnosis of a VSD alone does not establish that this operation was performed.
Can modifier 50 be reported?
No. The code’s descriptor and anatomy make a bilateral adjustment inappropriate.
How are multiple procedures handled in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires 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 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.
4,00933602,,Closure of valve,A,,28.61,11.49,NA,11.49,,7.22,47.32,47.32,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,01033606,,Anastomosis/artery-aorta,A,,30.74,11.74,NA,11.74,,7.74,50.22,50.22,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,01133608,,Repair anomaly w/conduit,A,,31.08,11.98,NA,11.98,,7.84,50.90,50.90,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,01233610,,Repair by enlargement,A,,30.62,11.88,NA,11.88,,7.72,50.22,50.22,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,01333611,,Repair double ventricle,A,,34.68,10.96,NA,10.96,,8.74,54.38,54.38,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,01433612,,Repair double ventricle,A,,35.66,11.15,NA,11.15,,9.00,55.81,55.81,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,01533615,,Repair modified fontan,A,,34.99,12.25,NA,12.25,,8.82,56.06,56.06,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00