CPT code 33214: Pacemaker upgrade, existing system to expanded configuration2026 Medicare rate & RVUs in Maryland
Report this service when an existing pacemaker system is surgically upgraded, such as converting a single-chamber system to dual-chamber pacing.
CMS doesn’t publish an office rate for 33214 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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On this page 9 sections
What 33214 covers
A pacemaker upgrade changes an existing implanted pacing system to support a different configuration. A common situation is converting a single-chamber system to dual-chamber pacing by adding an atrial lead and adapting or replacing the pulse generator as needed. Cardiologists and electrophysiologists typically perform the procedure in a hospital or outpatient surgical facility, with imaging and device testing used to guide and assess the work.
Select this code when the operative service upgrades the existing system, not when the physician only replaces a pulse generator or inserts a new system. Document the preexisting and resulting configurations, the leads placed or retained, generator work, and the reason for the upgrade. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant payment requires documented medical necessity; co-surgeons are permitted, but team surgery 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 33214 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 | $451.87 |
| Rest of Maryland | Unavailable | $424.77 |
| Washington, DC area | Unavailable | $466.91 |
How the 33214 rate is calculated
Each of 33214’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 · 33214
RVUs × geographic indexes × conversion factor
Work7.40
7.40 RVUs× 1.000 GPCI
Practice expense3.63
3.63 RVUs× 1.000 GPCI
Malpractice1.71
1.71 RVUs× 1.000 GPCI
Adjusted RVUs
12.7400
Conversion factor
$33.4009
Medicare rate
$425.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33214
33214 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33214
Pacemaker upgrade, existing system to expanded configuration
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 33214
Pacemaker upgrade, existing system to expanded configuration
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
33214 without 51 · national facility
$425.53
Pacemaker upgrade, existing system to expanded configuration
33214-51 · Second procedure: 50%
$212.77
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%).
33214 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33208Pacemaker implantAtrial and ventricular leads
- Choose 33208 for implantation of a new dual-chamber pacemaker system. Choose 33214 when the procedure upgrades an already implanted system.
- 33216ICD lead insertionSingle transvenous lead
- 33216 describes inserting one lead into an existing system. This code is for an upgrade of the system configuration, rather than lead insertion alone.
- 33228Pacemaker generator exchangeDual-lead system
- 33228 describes generator removal and replacement in a dual-lead system. Use this code when the operative work upgrades the existing pacemaker configuration instead.
33214 billing questions
When should I report an upgrade rather than a new dual-chamber implant?
Use this code when the physician surgically changes an existing pacemaker system to a new configuration. A new dual-chamber implant, rather than an upgrade of an existing system, is represented by a different service.
Is this code appropriate for a generator-only replacement?
No. A generator exchange that leaves the pacing configuration unchanged is a generator-replacement service; this code describes changing the existing system configuration.
What documentation supports reporting the upgrade?
Record the existing and intended pacing configurations, the lead and generator work performed, and the clinical reason for changing the system. The operative report should make clear that the work upgraded the existing system.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this pacemaker system procedure.
How does the global period affect postoperative visits?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons are permitted; team surgery 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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