Office (non-facility) & facility
Historical · Q3 2020National (GPCI 1.000)
Facility-only: CMS developed no Office (non-facility) practice-expense RVUs for 33778 (NA indicator), so the file’s non-facility amount repeats the facility one.
$2,150.52–$3,174.49 across payment localities · Office (non-facility)Participating physician · Before sequestration
CMS evidence · Q3 2020 release
( Work42.75 × 1.000 + Practice exp.15.55 × 1.000 + Malpractice9.76 × 1.000 ) × Conv. factor$36.0896 = $2,456.26
F Work RVU
42.75
G Non‑facility PE RVU
15.55
K MP RVU
9.76
Y Conversion factor
36.0896
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Physician relative value file (PPRRVU) · PPRRVU20_V0618.csv row 8,536 in rvu20c-updated-06192020.zip Download from CMS
Loading rows 8,534–8,538 of PPRRVU20_V0618.csv…
Nationally priced under PFS, using the RVU formula.
CMS RVU20CJuly 1 – September 30, 2020
The national PFS baseline was $2,456.26 for CPT 33778 in the Office (non-facility) setting and $2,456.26 in a facility under the Q3 2020 Physician Fee Schedule, effective July 2020. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.
Contract rate as % of Medicare Copy link
Applies to your locality's allowed amount, not the $2,456.26 national baseline. How to find your contract's percentage.
Need rates from another insurer? Join the waitlist →
Allowed amount, Medicare's share, and patient share Copy link
A physician's $2,456.26 Office (non-facility) allowed amount: Medicare pays $1,925.71 after sequestration and the patient owes $491.25, once the Part B deductible is met.
| Billed by | Allowed amount | Participating claim | If not participating | ||
|---|---|---|---|---|---|
| What Medicare pays | Patient coinsurance | Non-participating amount | Limiting charge | ||
| Physician (MD/DO) 100% Calculator | $2,456.26 | $1,925.71 $1,965.01 − $39.30 | $491.25 | $2,333.45 | $2,683.47 |
| Physician assisting at surgery (-80, -81, -82) 16% Calculator | $393.00 | $308.11 $314.40 − $6.29 | $78.60 | Not shown for assistant rows | |
National Q3 2020, GPCI 1.000. Each % applies before the 80/20 split and sequestration.
For the ZIP in the price card
Is $2,456.26 what a practice actually receives?
It's the national allowed amount—the starting point. Medicare pays 80% of it ($1,965.01) and the patient owes 20% coinsurance ($491.25). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. That payment is practice revenue that covers staff, space, equipment, and billing. It isn't the clinician's take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.
Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).
What's the non-participating amount for 33778?
$2,333.45 in the Office (non-facility) setting—95% of the $2,456.26 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
What's the limiting charge for 33778?
$2,683.47 in the Office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $2,456.26 amount above. The non-participating amount is 95% of the fee schedule rate ($2,333.45), and the statutory cap is 115% of that. See limiting charge.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
CMS RVU20CJuly 1 – September 30, 2020 See file rows
Which billing rules and modifiers apply? Copy link
National modifier amounts for 33778: -80/81/82 $393.00 · -AS $334.05 · -62 $1,535.16 if documented.
90-day follow-up
GLOB DAYS
090
Major surgery. The fee covers the day before surgery, the day of surgery, and the 90 days after it. Related follow-up care inside that window is not billed separately.
Standard reduction applies
MULT PROC
2
When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each.
-51 depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one.
Payable
ASST SURG
2
An assistant at surgery may be separately paid for this procedure, typically as a percentage of the fee schedule amount.
Payable with documentation
CO SURG
1
Co-surgeons may be paid, but only with supporting documentation establishing the medical necessity of two surgeons.
Not payable with 33778: -26/TC · -50 · -66.
Modifier amounts are derived, not a CMS column: Localis applies the standard MPFS percentage to the national Office (non-facility) amount. Check them against the Claims Processing Manual. If documented means paid only when documentation of medical necessity is submitted. Locality-adjusted amounts.
Why would a Medicare claim for 33778 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- 33778 carries a 90-day global period—routine post-operative care within that window is included in the surgical payment rather than paid on its own claim. See how it's computed
- Bilateral surgery: no bilateral adjustment. See billing policy
- Co-surgeons: payable with documentation. See billing policy
- Team surgery: not permitted. See billing policy
- Multiple procedures: standard reduction applies. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
CMS RVU20CJuly 1 – September 30, 2020 See file rows
Can you bill it with another code? Copy link
Payment review for 33778 Copy link
What to check (5)
Four published payment rules can change what 33778 allows on a claim: facility-only practice-expense pricing, the 90-day global package, the standard multiple-procedure reduction and assistant-at-surgery payment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.
- Check the place of service: CMS marks this code facility-only (an NA in the non-facility NA indicator) and developed no Office (non-facility) practice-expense RVUs for it; the file’s non-facility column repeats the facility value.
- Check the dates before appealing a denial: related follow-up care in the 90 days after the procedure is already paid in this fee, so a post-operative visit denied in that window was denied correctly.
- Rank the claim’s procedure lines before calling this one short-paid: billed with a higher-valued procedure on the same date, its allowed amount is $1,228.13 instead of $2,456.26 (national, GPCI 1.000). That is the rule, not a payer error.
- Check that any -80 or -AS line was priced from the same release and locality as the primary line; an assistant at surgery prices at a percentage of the fee-schedule amount.
- Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
How location and RVUs set the amount Copy link
Office (non-facility) and facility: 68.06 RVUs × $36.0896 = $2,456.26 national PFS baseline. Local GPCIs move it from $2,150.52 in Nebraska, NE to $3,174.49 in Alaska, AK.
Office (non-facility) and facility
| Component | RVU | × GPCI | = |
|---|---|---|---|
| Work | 42.75 | 1.000 | 42.75 |
| Practice expense | 15.55 | 1.000 | 15.55 |
| Malpractice | 9.76 | 1.000 | 9.76 |
| Total RVUs | 68.06 | ||
| × Conversion factor | $36.0896 | ||
| = National PFS baseline | $2,456.26 | ||
Rates by locality Copy link
33778 Office (non-facility) by metro, highest first
Show 56 more metros Show fewer metros
33778 Facility by metro, highest first
Show 56 more metros Show fewer metros
Q3 2020, each locality's GPCIs, before sequestration. Multi-locality states are shaded by their mean. Look up your exact locality →
CMS RVU20CJuly 1 – September 30, 2020 See file rows
Source & method Copy link
-
01 PPRRVU20_V0618.csv · Q3 2020 (RVU20C) · row 8,536—status A, RVUs limits
- Effective
- July 1 – September 30, 2020
- Locator
- PPRRVU20_V0618.csv in rvu20c-updated-06192020.zip · row 8,536 of 17,320 · via CMS
- Fields read
-
Status A (col 4) Work RVU 42.75 (col 6) Office (non-facility) PE RVU 15.55 (col 7) Facility PE RVU 15.55 (col 9) Malpractice RVU 9.76 (col 11)SHA-256 ebde66539c09d959…
- Doesn’t establish
- A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
- Note
- Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
-
02 Conversion factor · same file · row 8,536 · column 25—$36.0896
- Source
- Conversion factor, read from the same file as the RVUs
-
03 Derived Modifier amounts—calculated by Localis from standard MPFS percentages limits
- Source
- Modifier amounts apply standard MPFS percentages to this code’s billing indicators.
- Doesn’t establish
- A CMS-published amount: we derive these rather than read them from CMS. Confirm them against the current Claims Processing Manual before relying on them for payment.
Cite this rate
CPT 33778 National PFS baseline: Office (non-facility) $2,456.26; Facility $2,456.26 (Q3 2020; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU20C, PPRRVU20_V0618.csv row 8,536. Localis. https://localishealth.com/cpt/33778/2020/C
Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON
How has it changed? Copy link
$2,190.77 Office (non-facility) and $2,190.77 Facility since Jan 1, 2026, after a -2.4% decrease in the Office (non-facility) amount. -9.4% decrease since Q1 2013; peak $2,606.62 in Q4 2015.
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Jan 1, 2026 – present
Q1 2026
Still in effect · 4 releases at this rate- Office
- $2,190.77 (−$53.43, -2.4% decrease)
- Facility
- $2,190.77 (−$53.43, -2.4% decrease)
Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present
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Jan 1, 2025 – Dec 31, 2025
Q1 2025
4 releases at this rate- Office
- $2,244.20 (−$60.63, -2.6% decrease)
- Facility
- $2,244.20 (−$60.63, -2.6% decrease)
Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025
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Mar 9, 2024 – Dec 31, 2024
Q1 2024
4 releases at this rate- Office
- $2,304.83 (+$37.62, +1.7% increase)
- Facility
- $2,304.83 (+$37.62, +1.7% increase)
Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024
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Jan 1, 2024 – Mar 8, 2024 · Superseded revision
Q1 2024 rev 1
Revision 1, later corrected by CMS- Office
- $2,267.21
- Facility
- $2,267.21
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Jan 1, 2023 – Dec 31, 2023
Q1 2023
4 releases at this rate- Office
- $2,336.18 (−$48.88, -2.0% decrease)
- Facility
- $2,336.18 (−$48.88, -2.0% decrease)
Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023
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Jan 1, 2022 – Dec 31, 2022
Q1 2022
4 releases at this rate- Office
- $2,385.06 (−$11.05, -0.5% decrease)
- Facility
- $2,385.06 (−$11.05, -0.5% decrease)
Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022
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Jan 1, 2021 – Dec 31, 2021
Q1 2021
4 releases at this rate- Office
- $2,396.11 (−$60.15, -2.4% decrease)
- Facility
- $2,396.11 (−$60.15, -2.4% decrease)
Q1 2021 Jan 1, 2021 – Mar 31, 2021 · Q2 2021 Apr 1, 2021 – Jun 30, 2021 · Q3 2021 Jul 1, 2021 – Sep 30, 2021 · Q4 2021 Oct 1, 2021 – Dec 31, 2021
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Jan 1, 2020 – Dec 31, 2020
Q1 2020
4 releases at this rate- Office
- $2,456.26 (−$5.21, -0.2% decrease)
- Facility
- $2,456.26 (−$5.21, -0.2% decrease)
Q1 2020 Jan 1, 2020 – Mar 31, 2020 · Q2 2020 Apr 1, 2020 – Jun 30, 2020 · Q3 2020 Jul 1, 2020 – Sep 30, 2020 · Q4 2020 Oct 1, 2020 – Dec 31, 2020
- −$15.52 malpractice RVUs
- +$6.86 practice-expense RVUs
- +$3.45 the conversion factor
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Jan 1, 2019 – Dec 31, 2019
Q1 2019
4 releases at this rate- Office
- $2,461.47 (+$5.94, +0.2% increase)
- Facility
- $2,461.47 (+$5.94, +0.2% increase)
Q1 2019 Jan 1, 2019 – Mar 31, 2019 · Q2 2019 Apr 1, 2019 – Jun 30, 2019 · Q3 2019 Jul 1, 2019 – Sep 30, 2019 · Q4 2019 Oct 1, 2019 – Dec 31, 2019
- +$6.13 malpractice RVUs
- −$2.88 practice-expense RVUs
- +$2.69 the conversion factor
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Jan 1, 2018 – Dec 31, 2018
Q1 2018
4 releases at this rate- Office
- $2,455.53 (−$3.20, -0.1% decrease)
- Facility
- $2,455.53 (−$3.20, -0.1% decrease)
Q1 2018 Jan 1, 2018 – Mar 31, 2018 · Q2 2018 Apr 1, 2018 – Jun 30, 2018 · Q3 2018 Jul 1, 2018 – Sep 30, 2018 · Q4 2018 Oct 1, 2018 – Dec 31, 2018
- +$7.60 the conversion factor
- −$7.56 practice-expense RVUs
- −$3.24 malpractice RVUs
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Jan 1, 2017 – Dec 31, 2017
Q1 2017
4 releases at this rate- Office
- $2,458.73 (−$129.92, -5.0% decrease)
- Facility
- $2,458.73 (−$129.92, -5.0% decrease)
Q1 2017 Jan 1, 2017 – Mar 31, 2017 · Q2 2017 Apr 1, 2017 – Jun 30, 2017 · Q3 2017 Jul 1, 2017 – Sep 30, 2017 · Q4 2017 Oct 1, 2017 – Dec 31, 2017
- −$132.79 practice-expense RVUs
- +$6.10 the conversion factor
- −$3.23 malpractice RVUs
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Jan 1, 2016 – Dec 31, 2016
Q1 2016
4 releases at this rate- Office
- $2,588.65 (−$17.97, -0.7% decrease)
- Facility
- $2,588.65 (−$17.97, -0.7% decrease)
Q1 2016 Jan 1, 2016 – Mar 31, 2016 · Q2 2016 Apr 1, 2016 – Jun 30, 2016 · Q3 2016 Jul 1, 2016 – Sep 30, 2016 · Q4 2016 Oct 1, 2016 – Dec 31, 2016
- −$10.39 malpractice RVUs
- −$9.37 the conversion factor
- +$1.79 practice-expense RVUs
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Oct 1, 2015 – Dec 31, 2015
- Office
- $2,606.62 (+$282.21, +12.1% increase)
- Facility
- $2,606.62 (+$282.21, +12.1% increase)
- +$270.59 malpractice RVUs
- +$11.62 the conversion factor
-
Jan 1, 2015 – Sep 30, 2015
Q1 2015
3 releases at this rate- Office
- $2,324.41 (−$272.38, -10.5% decrease)
- Facility
- $2,324.41 (−$272.38, -10.5% decrease)
Q1 2015 Jan 1, 2015 – Mar 31, 2015 · Q2 2015 Apr 1, 2015 – Jun 30, 2015 · Q3 2015 Jul 1, 2015 – Sep 30, 2015
- −$265.29 malpractice RVUs
- −$4.94 the conversion factor
- −$2.15 practice-expense RVUs
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Apr 1, 2014 – Dec 31, 2014
Q2 2014
3 releases at this rate- Office
- $2,596.79 (+$178.78, +7.4% increase)
- Facility
- $2,596.79 (+$178.78, +7.4% increase)
Q2 2014 Apr 1, 2014 – Jun 30, 2014 · Q3 2014 Jul 1, 2014 – Sep 30, 2014 · Q4 2014 Oct 1, 2014 – Dec 31, 2014
- +$127.91 the conversion factor
- +$67.71 practice-expense RVUs
- −$16.84 malpractice RVUs
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Jan 1, 2013 – Jun 30, 2013
Q1 2013
2 releases at this rate- Office
- $2,418.01
- Facility
- $2,418.01
Q1 2013 Jan 1, 2013 – Mar 31, 2013 · Q2 2013 Apr 1, 2013 – Jun 30, 2013
Earliest release in this history.
National baseline (GPCI 1.000), before sequestration.
How each change is split
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
The 33778 rate last moved in Q1 2026. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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