CPT code 33208: Pacemaker implant, atrial and ventricular leads2026 Medicare rate & RVUs in Montana
Implantation of a permanent dual-chamber pacemaker with transvenous atrial and ventricular leads when pacing support is needed in both chambers.
In Montana, Medicare pays $455.79 for 33208 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 33208 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How Montana compares for 33208
Across 109 of 109 payment localities, the facility rate for 33208 runs from $406.10 in Wisconsin to $572.82 in Alaska. Montana pays $455.79. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$455.79
- Los Angeles, CA · California$466.14+$10.35
- Washington, DC area · District of Columbia$498.43+$42.64
- Miami, FL · Florida$560.15+$104.36
- Chicago, IL · Illinois$542.78+$86.99
- Manhattan, NY · New York$530.20+$74.41
- Alaska · Alaska$572.82+$117.03
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $413.50 |
| ArkansasArkansas | — | $408.37 |
| ArizonaArizona | — | $443.03 |
| Bakersfield, CACalifornia | — | $446.60 |
| Chico, CACalifornia | — | $441.29 |
| El Centro, CACalifornia | — | $441.62 |
| Fresno, CACalifornia | — | $441.29 |
| Hanford, CACalifornia | — | $441.29 |
| Madera, CACalifornia | — | $441.29 |
| Merced, CACalifornia | — | $441.29 |
| Modesto, CACalifornia | — | $441.29 |
| Napa, CACalifornia | — | $477.37 |
| Oxnard, CACalifornia | — | $459.75 |
| Redding, CACalifornia | — | $441.29 |
| Rest of CaliforniaCalifornia | — | $441.29 |
| Riverside, CACalifornia | — | $462.21 |
| Sacramento, CACalifornia | — | $454.15 |
| Salinas, CACalifornia | — | $452.31 |
| San Diego, CACalifornia | — | $456.61 |
| Marin County, CACalifornia | — | $493.48 |
| San Francisco, CACalifornia | — | $491.26 |
| San Benito County, CACalifornia | — | $506.28 |
| Santa Clara County, CACalifornia | — | $497.23 |
| San Luis Obispo, CACalifornia | — | $446.16 |
| Santa Cruz, CACalifornia | — | $455.87 |
| Santa Maria, CACalifornia | — | $452.27 |
| Santa Rosa, CACalifornia | — | $459.84 |
| Stockton, CACalifornia | — | $441.29 |
| Vallejo, CACalifornia | — | $474.18 |
| Visalia, CACalifornia | — | $441.29 |
| Yuba City, CACalifornia | — | $441.29 |
| ColoradoColorado | — | $452.24 |
| ConnecticutConnecticut | — | $483.87 |
| DelawareDelaware | — | $449.37 |
| Fort Lauderdale, FLFlorida | — | $510.02 |
| Rest of FloridaFlorida | — | $483.70 |
| Atlanta, GAGeorgia | — | $471.66 |
| Rest of GeorgiaGeorgia | — | $456.20 |
| Hawaii, Guam, HIHawaii | — | $444.01 |
| IowaIowa | — | $407.02 |
| IdahoIdaho | — | $412.54 |
| East St. Louis, ILIllinois | — | $512.91 |
| Rest of IllinoisIllinois | — | $482.74 |
| Suburban Chicago, ILIllinois | — | $511.20 |
| IndianaIndiana | — | $414.18 |
| KansasKansas | — | $412.75 |
| KentuckyKentucky | — | $437.82 |
| New Orleans, LALouisiana | — | $458.10 |
| Rest of LouisianaLouisiana | — | $440.17 |
| Metropolitan Boston, MAMassachusetts | — | $482.10 |
| Rest of MassachusettsMassachusetts | — | $453.14 |
| Baltimore area, MDMaryland | — | $484.07 |
| Rest of MarylandMaryland | — | $454.72 |
| Rest of MaineMaine | — | $422.24 |
| Southern Maine, MEMaine | — | $430.87 |
| Detroit, MIMichigan | — | $496.64 |
| Rest of MichiganMichigan | — | $454.47 |
| MinnesotaMinnesota | — | $413.35 |
| Metropolitan Kansas City, MOMissouri | — | $447.52 |
| Metropolitan St. Louis, MOMissouri | — | $450.62 |
| Rest of MissouriMissouri | — | $438.60 |
| MississippiMississippi | — | $423.18 |
| North CarolinaNorth Carolina | — | $424.82 |
| North DakotaNorth Dakota | — | $417.23 |
| NebraskaNebraska | — | $406.69 |
| New HampshireNew Hampshire | — | $452.42 |
| Northern New JerseyNew Jersey | — | $495.95 |
| Rest of New JerseyNew Jersey | — | $483.76 |
| New MexicoNew Mexico | — | $459.62 |
| NevadaNevada | — | $445.16 |
| NYC suburbs and Long Island, NYNew York | — | $550.90 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $492.85 |
| Queens, NYNew York | — | $523.08 |
| Rest of New YorkNew York | — | $430.92 |
| OhioOhio | — | $446.59 |
| OklahomaOklahoma | — | $429.28 |
| Portland, OROregon | — | $456.26 |
| Rest of OregonOregon | — | $436.13 |
| Metropolitan Philadelphia, PAPennsylvania | — | $478.13 |
| Rest of PennsylvaniaPennsylvania | — | $443.06 |
| Puerto RicoPuerto Rico | — | $456.19 |
| Rhode IslandRhode Island | — | $457.90 |
| South CarolinaSouth Carolina | — | $437.55 |
| South DakotaSouth Dakota | — | $412.67 |
| TennesseeTennessee | — | $415.46 |
| Austin, TXTexas | — | $455.62 |
| Beaumont, TXTexas | — | $441.11 |
| Brazoria, TXTexas | — | $442.79 |
| Dallas, TXTexas | — | $448.72 |
| Fort Worth, TXTexas | — | $448.43 |
| Galveston, TXTexas | — | $446.15 |
| Houston, TXTexas | — | $481.84 |
| Rest of TexasTexas | — | $443.83 |
| UtahUtah | — | $442.49 |
| VirginiaVirginia | — | $434.85 |
| Virgin Islands, VIUnited States Virgin Islands | — | $456.19 |
| VermontVermont | — | $422.61 |
| Rest of WashingtonWashington | — | $449.97 |
| King County, WAWashington | — | $483.58 |
| WisconsinWisconsin | — | $406.10 |
| West VirginiaWest Virginia | — | $469.16 |
| WyomingWyoming | — | $438.99 |
33208 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
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.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
3,837
- Code
- 33208
- Physician work
- 8.31
- Practice expense
- 3.39
- Malpractice
- 1.95
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.31 | × 1.000 | 8.3100 |
| Practice expense | 3.39 | × 1.000 | 3.3900 |
| Malpractice | 1.95 | × 0.998 | 1.9461 |
| Total RVUs | 13.6461 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Montana$455.79
Facility: (8.31 × 1 + 3.39 × 1 + 1.95 × 0.998) × $33.4009 = $455.79
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%).
How 33208 has changed in Montana
33208 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $455.79 | RVU26D |
| 2026-07-01 | Not available in this setting | $455.79 | RVU26C |
| 2026-04-01 | Not available in this setting | $455.79 | RVU26B |
| 2026-01-01 | Not available in this setting | $455.79 | RVU26A |
| 2025-10-01 | Not available in this setting | $493.54 | RVU25D |
| 2025-07-01 | Not available in this setting | $493.54 | RVU25C |
| 2025-04-01 | Not available in this setting | $493.54 | RVU25B |
| 2025-01-01 | Not available in this setting | $493.54 | RVU25A |
| 2024-10-01 | Not available in this setting | $506.22 | RVU24D |
| 2024-07-01 | Not available in this setting | $506.22 | RVU24C |
| 2024-04-01 | Not available in this setting | $506.22 | RVU24B |
| 2024-03-09 | Not available in this setting | $506.22 | RVU24AR |
| 2024-01-01 | Not available in this setting | $497.96 | RVU24A |
| 2023-10-01 | Not available in this setting | $517.74 | RVU23D |
| 2023-07-01 | Not available in this setting | $517.74 | RVU23C |
| 2023-04-01 | Not available in this setting | $517.74 | RVU23B |
| 2023-01-01 | Not available in this setting | $517.74 | RVU23A |
| 2022-10-01 | Not available in this setting | $530.34 | RVU22D |
| 2022-07-01 | Not available in this setting | $530.34 | RVU22C |
| 2022-04-01 | Not available in this setting | $530.34 | RVU22B |
| 2022-01-01 | Not available in this setting | $530.34 | RVU22A |
| 2021-10-01 | Not available in this setting | $532.68 | RVU21D |
| 2021-07-01 | Not available in this setting | $532.68 | RVU21C |
| 2021-04-01 | Not available in this setting | $532.68 | RVU21B |
| 2021-01-01 | Not available in this setting | $532.68 | RVU21A |
| 2020-10-01 | Not available in this setting | $566.77 | RVU20D |
| 2020-07-01 | Not available in this setting | $566.77 | RVU20C |
| 2020-04-01 | Not available in this setting | $566.77 | RVU20B |
| 2020-01-01 | Not available in this setting | $566.77 | RVU20A |
| 2019-10-01 | Not available in this setting | $590.79 | RVU19D |
| 2019-07-01 | Not available in this setting | $590.79 | RVU19C |
| 2019-04-01 | Not available in this setting | $590.79 | RVU19B |
| 2019-01-01 | Not available in this setting | $590.79 | RVU19A |
| 2018-10-01 | Not available in this setting | $588.74 | RVU18D |
| 2018-07-01 | Not available in this setting | $588.74 | RVU18C |
| 2018-04-01 | Not available in this setting | $588.74 | RVU18B |
| 2018-01-01 | Not available in this setting | $588.74 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $573.69 | RVU17D |
| 2017-07-01 | Not available in this setting | $573.69 | RVU17C |
| 2017-04-01 | Not available in this setting | $573.69 | RVU17B |
| 2017-01-01 | Not available in this setting | $573.69 | RVU17A |
| 2016-10-01 | Not available in this setting | $570.04 | RVU16D |
| 2016-07-01 | Not available in this setting | $570.04 | RVU16C |
| 2016-04-01 | Not available in this setting | $570.04 | RVU16B |
| 2016-01-01 | Not available in this setting | $570.04 | RVU16A |
| 2015-10-01 | Not available in this setting | $570.42 | RVU15D |
| 2015-07-01 | Not available in this setting | $570.42 | RVU15C |
| 2015-04-01 | Not available in this setting | $567.58 | RVU15B |
| 2015-01-01 | Not available in this setting | $567.58 | RVU15A |
| 2014-10-01 | Not available in this setting | $555.38 | RVU14D |
| 2014-07-01 | Not available in this setting | $555.38 | RVU14C |
| 2014-04-01 | Not available in this setting | $555.38 | RVU14B |
| 2014-01-01 | Not available in this setting | $555.38 | RVU14A |
| 2013-10-01 | Not available in this setting | $532.38 | RVU13D |
| 2013-07-01 | Not available in this setting | $532.38 | RVU13C |
| 2013-04-01 | Not available in this setting | $532.38 | RVU13B |
| 2013-01-01 | Not available in this setting | $532.38 | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
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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