Among the many proposals SCAI is following in the proposed 2026 Medicare Physician Fee Schedule (MPFS) is a significant reduction to the RVU for CPT code 33340 for left atrial appendage closure (LAAO). The reduction stems from a re-valuation proposal put forth by the American Medical Association’s Relative Value Scale Update Committee (RUC). SCAI takes part in RUC deliberations and strongly expressed its objections to this reduction even before it made its way to CMS. Unfortunately, CMS has now proposed to accept the RUC recommendation of a work RVU reduction from 14.00 to 10.25 based on recent survey data.  

The value is then further reduced by other policies CMS introduces in the MPFS. Specifically, a new 2.5% “efficiency adjustment” seeks to decrease non-time-based services. This would further reduce the work RVU to 9.99 for this code. The proposed adjustment makes no exception for services like LAAO that have recently been revalued.  

In addition, CMS is also proposing to reduce indirect practice expense (PE) for procedures performed in a facility, which results in about another 10% reduction in value. This additional adjustment would result in a final potential reduction to LAAO of 35%. Since CMS has a policy that any reimbursement reduction cannot exceed 20% in one year, the cut will be phased in over two years. 

SCAI has met with CMS on several occasions about this matter, along with ACC and HRS. We will continue to advocate against this critical cut. SCAI strongly suggests that you also submit comments to let CMS know that this cut is not acceptable. Please use this template letter to submit your comments before September 12, 2025. 

LAAO Reimbursement Reduction Explained: 

1. The full impact of changes to work RVUs and other policies would be a roughly 35% reduction to LAAO in 2027, reducing the total RVU to 14.91 from its current value of 22.87. 
2. This stems in part from the 27% reduction in work RVUs from 14.00 to 10.25 in the 2026 physician fee schedule.  
3. CMS also proposes an efficiency adjustment reducing non-time-based services by 2.5%. This proposed adjustment makes no exception for services like LAAO that have recently been revalued. 
4. CMS believes the trend of physician practices moving toward hospital employment/ownership is lowering physician overhead costs. To account for this, CMS is proposing to reduce indirect practice expense (PE) attributed to most services provided in hospitals. This reduction would lower affected services by about 10% of their current total RVU and would affect LAAO in 2027. 
5. In addition to the broad indirect PE policy change, PE for LAAO would also go down because a portion of indirect PE is directly linked to work RVU. This reduces the current total RVU by about an additional 5% in 2027. 
6. Similarly, the liability RVU is also directly linked to the work RVU and would be reduced. 
7. Because these multiple reductions exceed a 20% total reduction in RVUs, the cuts will be phased in over two years. For 2026, the total reduction would be 19% from 2025 or a total RVU of 18.52, down from the current value of 22.87. The rest of the large cut would be implemented in 2027 (see 2027 row). The PE RVUs increase slightly for 2026 in order to limit the total reduction to 19% in year one, before dropping to capture the full 35% in 2027.