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See a sample rate comparisonCPT 33416 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Heart Muscle Surgery, Surgery To Reduce An Oversized Heart Muscle (Septum) Between The Lower Heart Chambers (Ventricles). The Muscle Is Blocking Blood Flow From The Left Ventricle.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Cardiovascular System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | 51 - Multiple procedures AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | $1,902.18 national non-facility rate (2026) · View Medicare rates for 33416 |
| Medicaid Fee Schedule | $1,485.185 median of the 8 states in the free preview · View Medicaid rates for 33416 |
National average reimbursement for CPT 33416 by major payers:
$2,589.05
$2,780.80
$3,046.05
$3,233.92
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CPT 33416
5 of 25 sample ratesHigher to lower in this preview
Monterey Peninsula Surgery Center Munras Ave
Monterey Peninsula Surgery Center, LLC
$6,158.00Published ratePoint Of Rocks Surgery Center, LLC
$1,028.00Published rateThe Ent Center Of Rhode Island LLC, The Surgery Center Of Rhode Island
The Ent Center Of Rhode Island
$706.00Published rateWnc Eye Surgery Centers Inc
$475.00Published rateNorth Valley Endoscopy Center LLC
$109.00Published rate
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See a sample payer proposalCPT 33416 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 33416 code is part of the Surgery services used for Surgical Procedures on the Cardiovascular System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 33416 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 33412-CPT | High | Surgery To Replace Heart Valve, Surgery To Replace A Valve Between The Lower Left Heart Chamber And The Aorta. The Replacement May Be Fully Artificial Or Made Of Biologically Similar Tissue. Heart-Lung Bypass Allows The Heart To Rest During Surgery. |
| 33413-CPT | High | Heart Valve Replacement, Surgery To Replace A Heart Valve (Aortic Valve) Using A Similar Valve (Pulmonic Valve) From The Same Heart. The Pulmonic Valve Is Replaced With An Artificial One. |
| 33414-CPT | High | Heart Chamber Modification, Surgery To Modify Parts Of The Left Ventricle (Main Pumping Chamber Of The Heart). The Procedure Enables Blood To Flow Freely Out Of The Heart. |
| 33416-CPT | High | Heart Muscle Surgery, Surgery To Reduce An Oversized Heart Muscle (Septum) Between The Lower Heart Chambers (Ventricles). The Muscle Is Blocking Blood Flow From The Left Ventricle. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 33416. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 33416 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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