CPT code 33208: Pacemaker implant, atrial and ventricular leads2026 Medicare rate & RVUs in Maryland
Implantation of a permanent dual-chamber pacemaker with transvenous atrial and ventricular leads when pacing support is needed in both chambers.
CMS doesn’t publish an office rate for 33208 in Maryland.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 33208 covers
This service covers placement of a permanent dual-chamber transvenous pacemaker: one lead is positioned in the right atrium and another in the right ventricle, then connected to a pulse generator placed in a pocket. Electrophysiologists and cardiologists typically perform the procedure in a hospital electrophysiology laboratory or a comparable procedural setting for patients needing pacing in both chambers.
Report the code once for the dual-chamber system, not separately for each lead. The operative report should support the indication, lead locations, generator placement, and system configuration. Medicare includes the day-before preoperative visit and 90 days of related postoperative care in the global period. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Medicare does not pay an assistant-at-surgery claim for this service. Co-surgeons are permitted; team-surgery billing is not permitted.
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.
Where 33208 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $484.07 |
| Rest of Maryland | Unavailable | $454.72 |
| Washington, DC area | Unavailable | $498.43 |
How the 33208 rate is calculated
Each of 33208’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 33208
RVUs × geographic indexes × conversion factor
Work8.31
8.31 RVUs× 1.000 GPCI
Practice expense3.39
3.39 RVUs× 1.000 GPCI
Malpractice1.95
1.95 RVUs× 1.000 GPCI
Adjusted RVUs
13.6500
Conversion factor
$33.4009
Medicare rate
$455.92
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33208
33208 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33208
Pacemaker implant, atrial and ventricular leads
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 2 | Permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 33208
Pacemaker implant, atrial and ventricular leads
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33208 without 51 · national facility
$455.92
Pacemaker implant, atrial and ventricular leads
33208-51 · Second procedure: 50%
$227.96
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
33208 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33206Pacemaker implantAtrial pacing system
- 33206 describes an atrial single-chamber pacemaker. Choose 33208 when the implanted system has both atrial and ventricular transvenous leads.
- 33207Pacemaker insertionVentricular-only system
- 33207 describes a ventricular single-chamber pacemaker. Choose 33208 when both atrial and ventricular chambers are included in the implanted system.
- 33213Pacemaker generatorExisting dual leads
- 33213 covers pulse-generator insertion or replacement for a dual-lead system. It is not the complete dual-chamber implant represented by 33208.
- 33214Pacemaker upgradeExisting system to expanded configuration
- 33214 describes upgrading an existing pacemaker system. Use 33208 for implantation of a new dual-chamber transvenous system.
33208 billing questions
How does 33208 differ from 33206 or 33207?
Use 33208 for a dual-chamber system with both atrial and ventricular transvenous leads. Codes 33206 and 33207 describe single-chamber systems.
Should the leads and generator be billed separately?
For a complete dual-chamber implant, report 33208 once rather than billing separate lines for its atrial lead, ventricular lead, and generator.
When is 33213 used instead?
33213 is for insertion or replacement of a pulse generator in a dual-lead system without the complete lead-and-generator implantation represented by 33208.
How many units should be reported?
Report one unit for the dual-chamber system, not one unit for each transvenous lead.
How are assistant and co-surgeon claims handled?
Medicare does not pay an assistant-at-surgery claim for 33208. Co-surgeons are permitted when the operative circumstances support their separate roles; team-surgery billing 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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