No office rate
Both apply to complete Fallot repair without pulmonary atresia. This code is distinguished by pulmonary artery patch work; 33692 is used for the related repair without that patch distinction.
On this page
CMS RVU26D · Effective 2026-10-01
33694 Tetralogy repair Medicare reimbursement rates in Wisconsin
Reports complete surgical correction of tetralogy of Fallot without pulmonary atresia when the repair includes a pulmonary artery patch. Compare 33694 office and facility rates across CMS payment localities in Wisconsin.
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 33694 in Wisconsin?
Wisconsin has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1598.95
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
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.
Congenital cardiac surgery
About 33694: Complete Fallot repair with pulmonary artery patch
Reports complete surgical correction of tetralogy of Fallot without pulmonary atresia when the repair includes a pulmonary artery patch.
This code describes definitive surgical correction of tetralogy of Fallot in a patient without pulmonary atresia when a pulmonary artery patch is part of the repair. A congenital cardiac surgeon typically performs the operation in a hospital operating room. The repair addresses the ventricular septal defect and right ventricular outflow obstruction; the patch enlarges or reconstructs the pulmonary artery as required by the anatomy.
Select the code from the operative findings and documented procedures, including the absence of pulmonary atresia and use of a pulmonary artery patch. The operative report should support the complete repair and the patch work. The 90-day global period includes the day-before preoperative visit and related postoperative care during that period. When multiple 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. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 33694
- 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 RVU34.68 · 64%
- Practice expense (office) RVU10.96 · 20%
- Malpractice RVU8.74 · 16%
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.
33694 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
Use 33697 when pulmonary atresia is present. This code is for complete Fallot repair without pulmonary atresia and with a pulmonary artery patch.
33690
No office ratePulmonary artery banding
33690 describes pulmonary artery banding as a palliative operation. It does not represent definitive complete repair of tetralogy of Fallot.
Compare 33694 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.
1 of 1 payment localities
Wisconsin →
Office / nonfacility
Unavailable
Facility
$1598.95
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 33694 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
4,035
- Code
- 33694
- Physician work
- 34.68
- Practice expense
- 10.96
- Malpractice
- 8.74
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 34.68 | × 1.000 | 34.6800 |
| Practice expense | 10.96 | × 0.958 | 10.4997 |
| Malpractice | 8.74 | × 0.308 | 2.6919 |
| Total RVUs | 47.8716 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$1598.95
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 34.68 | 1 |
| Practice expense | 10.96 | 0.958 |
| Malpractice | 8.74 | 0.308 |
(34.68 × 1 + 10.96 × 0.958 + 8.74 × 0.308) × $33.4009 = $1598.95
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
33694 billing questions
How does this differ from 33692?
Both describe complete repair of tetralogy of Fallot without pulmonary atresia. Use 33694 when the repair includes a pulmonary artery patch; 33692 is the related code without that patch distinction.
When is 33697 used instead?
33697 is for complete repair when pulmonary atresia is present. The pulmonary anatomy and operative report should support that distinction.
Can the ventricular septal defect closure be billed separately?
The VSD closure is part of the complete Fallot repair described by this code. Do not separately report an isolated VSD-closure code for that integral work.
What documentation supports the pulmonary artery patch?
The operative report should identify the patch and describe its role in the pulmonary artery repair, along with the complete Fallot correction and the absence of pulmonary atresia.
How are other same-session procedures paid?
Under the standard multiple procedure rule, the highest-valued procedure is paid in full and other procedures performed in the same session are subject to a 50% reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and 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.
4,03233688,,Clsr 1vsd w/wo ptch rmvl bnd,A,,33.88,9.74,NA,9.74,,8.55,52.17,52.17,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,03333690,,Banding pulmonary artery,A,,19.85,9.76,NA,9.76,,4.99,34.60,34.60,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,03433692,,Comp rpr tof wo pulm atresia,A,,35.25,10.01,NA,10.01,,8.90,54.16,54.16,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,03533694,,Cmp rpr tof wo plm atrs ptch,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
4,03633697,,Compl rpr tof w/pulm atresia,A,,36.63,11.34,NA,11.34,,9.24,57.21,57.21,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,03733702,,Repair of heart defects,A,,26.56,10.58,NA,10.58,,6.68,43.82,43.82,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,0383370F,,Ajcc brst cncr stage 0 docd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,