Billing code 33964: Cannula repositioningMedicare rate & RVUs in Washington
Reports open surgical repositioning of a peripheral ECMO or ECLS cannula in a patient aged 5 through 17 years.
CMS doesn’t publish an office rate for 33964 in Washington.
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 33964 covers
This service covers surgically exposing and moving a peripheral cannula to a better position while extracorporeal membrane oxygenation or extracorporeal life support is in use. It is selected for patients ages 5 through 17 when the repositioning is performed through an open approach, rather than percutaneously. Cardiothoracic or other appropriately qualified surgeons typically perform it in an operating room or intensive care setting when cannula position needs correction to support the circuit or address a positioning problem.
Report the code for the open repositioning service, not for initial cannula placement or cannula removal alone. The record should identify the patient’s age, the peripheral cannula, the reason for repositioning, the open approach, and the repositioning performed. 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 multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery, co-surgeon, and team-surgery payment require supporting documentation.
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 33964 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $441.59 |
| Seattle (King Cnty) | Unavailable | $469.08 |
How the 33964 rate is calculated
Each of 33964’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 · 33964
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.26Practice expense 2.05Malpractice 2.21
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 33964
The CMS indicators that decide how 33964 is paid alongside other services.
CMS payment indicators · 33964
Cannula repositioning
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33964 without 51 · national facility
$451.58
Cannula repositioning
33964-51 · Second procedure: 50%
$225.79
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%).
33964 compared with similar codes
Compare codes
33964 vs 33959 vs 33963 vs 33965: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 33959Cannula repositioning
- Both codes cover peripheral cannula repositioning in patients ages 5 through 17. Choose 33964 for an open approach and 33959 for a percutaneous approach.
- 33963ECMO cannula repositioning
- This is the open repositioning sibling for patients younger than 5 years; 33964 is for patients ages 5 through 17.
- 33965ECMO cannula removal
- 33965 reports peripheral cannula removal. Use 33964 when the service is repositioning the cannula rather than removing it.
33964 billing questions
How do I distinguish this code from 33959?
Both describe peripheral cannula repositioning for patients ages 5 through 17. Use this code for an open approach and 33959 for a percutaneous approach.
Is this code for initial cannula placement?
No. It describes repositioning a cannula already in place. Initial peripheral cannula insertion is reported with an insertion code, such as 33951–33954, based on the applicable approach and patient age.
Does the 0-day global include same-day care?
Yes. Same-day preoperative and postoperative care is included in this minor procedure’s 0-day global period.
Can modifier 50 be used when more than one cannula is repositioned?
No. Bilateral adjustment does not apply to this code, and modifier 50 is inappropriate. Document the cannula or cannulae repositioned and the work performed.
When is an assistant or co-surgeon payable?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon and team-surgery payment also require supporting documentation.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the same session 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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