No office rate
33476 describes RVOT revision, with or without enlargement, without pulmonary valve replacement. When replacement is performed with the revision, consider 33478.
On this page
CMS RVU26D · Effective 2026-10-01
33478 RVOT revision Medicare reimbursement rates in Wyoming
Reports surgical revision of the right ventricular outflow tract when reconstruction or enlargement is performed together with pulmonary valve replacement. Compare 33478 office and facility rates across CMS payment localities in Wyoming.
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 33478 in Wyoming?
Wyoming 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
$1434.74
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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.
Cardiac surgery
About 33478: Right ventricular outflow tract revision
Reports surgical revision of the right ventricular outflow tract when reconstruction or enlargement is performed together with pulmonary valve replacement.
This code describes open surgical revision of the right ventricular outflow tract (RVOT) combined with pulmonary valve replacement. A cardiac surgeon may perform it for a patient with congenital heart disease who has a failing prior RVOT repair or conduit, pulmonary valve dysfunction, or both. A familiar clinical setting is reoperation after tetralogy of Fallot repair when the RVOT requires reconstruction and the pulmonary valve is replaced.
Report the code when the operative record supports both RVOT revision, with or without enlargement, and pulmonary valve replacement; isolated pulmonary valve replacement is distinguished from this combined service. Documentation should identify the treated outflow tract, the reconstruction performed, and the valve replacement. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. 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. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 33478
- 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 RVU26.85 · 60%
- Practice expense (office) RVU11.11 · 25%
- Malpractice RVU6.75 · 15%
38
Medicare services in 2024 · #5526 by national volume
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.
33478 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
33475 covers pulmonary valve replacement without the combined RVOT revision captured by 33478.
No office rate
33477 is a transcatheter pulmonary valve procedure. 33478 describes open surgical RVOT revision performed with pulmonary valve replacement.
Compare 33478 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
Wyoming** →
Office / nonfacility
Unavailable
Facility
$1434.74
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 33478 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
3,970
- Code
- 33478
- Physician work
- 26.85
- Practice expense
- 11.11
- Malpractice
- 6.75
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 26.85 | × 1.000 | 26.8500 |
| Practice expense | 11.11 | × 1.000 | 11.1100 |
| Malpractice | 6.75 | × 0.740 | 4.9950 |
| Total RVUs | 42.9550 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$1434.74
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 26.85 | 1 |
| Practice expense | 11.11 | 1 |
| Malpractice | 6.75 | 0.74 |
(26.85 × 1 + 11.11 × 1 + 6.75 × 0.74) × $33.4009 = $1434.74
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.
33478 billing questions
Can 33475 also be reported for the valve replacement?
The pulmonary valve replacement is part of the combined service described by 33478. Do not separately report 33475 for that same replacement.
When is 33476 a better fit?
Use 33476 for RVOT revision with or without enlargement when pulmonary valve replacement is not performed. The presence of pulmonary valve replacement distinguishes 33478.
What documentation supports 33478?
The operative report should describe the RVOT revision or enlargement and the pulmonary valve replacement. A record describing only valve replacement does not support the combined service.
Can modifier 50 be used for work on both sides?
No. Modifier 50 is inappropriate for this code; CMS does not apply a bilateral adjustment.
How are other procedures in the same session paid?
Under the CMS multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation.
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.
3,96733475,,Replacement pulmonary valve,A,,41.34,13.19,NA,13.19,,9.80,64.33,64.33,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96833476,,Revision of heart chamber,A,,25.91,10.93,NA,10.93,,6.53,43.37,43.37,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,96933477,,Implant tcat pulm vlv perq,A,,24.38,5.11,NA,5.11,,4.23,33.72,33.72,0,000,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97033478,,Revision of heart chamber,A,,26.85,11.11,NA,11.11,,6.75,44.71,44.71,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97133496,,Repair prosth valve clot,A,,29.09,11.43,NA,11.43,,6.98,47.50,47.50,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97233500,,Repair heart vessel fistula,A,,27.24,10.78,NA,10.78,,6.53,44.55,44.55,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,97333501,,Repair heart vessel fistula,A,,19.02,8.62,NA,8.62,,4.55,32.19,32.19,0,090,0.09,0.84,0.07,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,