CPT code 33221: Pacemaker generator, existing multiple leads2026 Medicare rate & RVUs in California
Insertion of a pulse generator connected to an existing multiple-lead pacemaker system, typically when the leads remain in place and only the generator is implanted.
CMS doesn’t publish an office rate for 33221 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 33221 covers
Code 33221 describes placing a pacemaker pulse generator and connecting it to an existing multiple-lead pacing system. Electrophysiologists and other qualified cardiac surgeons commonly perform the procedure in a hospital operating room or electrophysiology setting. A typical clinical context is a multilead system, such as cardiac resynchronization pacing, whose leads are already in place and will be connected to the new generator.
Report 33221 when the procedure is limited to generator insertion with existing multiple leads; documentation should identify the existing leads and describe generator placement and connection. When the generator is removed and replaced, consider the replacement code for a multiple-lead system instead. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery are 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 33221 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $314.34 |
| Chico, CA | Unavailable | $310.83 |
| El Centro, CA | Unavailable | $311.05 |
| Fresno, CA | Unavailable | $310.83 |
| Hanford, CA | Unavailable | $310.83 |
| Los Angeles, CA | Unavailable | $328.94 |
| Madera, CA | Unavailable | $310.83 |
| Marin County, CA | Unavailable | $351.39 |
| Merced, CA | Unavailable | $310.83 |
| Modesto, CA | Unavailable | $310.83 |
| Napa, CA | Unavailable | $338.99 |
| Oxnard, CA | Unavailable | $324.72 |
| Redding, CA | Unavailable | $310.83 |
| Rest of California | Unavailable | $310.83 |
| Riverside, CA | Unavailable | $324.67 |
| Sacramento, CA | Unavailable | $320.62 |
| Salinas, CA | Unavailable | $319.34 |
| San Benito County, CA | Unavailable | $360.46 |
| San Diego, CA | Unavailable | $322.92 |
| San Francisco, CA | Unavailable | $349.93 |
| San Luis Obispo, CA | Unavailable | $314.91 |
| Santa Clara County, CA | Unavailable | $354.47 |
| Santa Cruz, CA | Unavailable | $322.84 |
| Santa Maria, CA | Unavailable | $319.46 |
| Santa Rosa, CA | Unavailable | $325.70 |
| Stockton, CA | Unavailable | $310.83 |
| Vallejo, CA | Unavailable | $336.88 |
| Visalia, CA | Unavailable | $310.83 |
| Yuba City, CA | Unavailable | $310.83 |
How the 33221 rate is calculated
Each of 33221’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 · 33221
RVUs × geographic indexes × conversion factor
Work5.41
5.41 RVUs× 1.000 GPCI
Practice expense2.84
2.84 RVUs× 1.000 GPCI
Malpractice1.29
1.29 RVUs× 1.000 GPCI
Adjusted RVUs
9.5400
Conversion factor
$33.4009
Medicare rate
$318.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33221
33221 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33221
Pacemaker generator, existing multiple 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) | 0 | Not 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 · 33221
Pacemaker generator, existing multiple 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
33221 without 51 · national facility
$318.64
Pacemaker generator, existing multiple leads
33221-51 · Second procedure: 50%
$159.32
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%).
33221 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33213Pacemaker generatorExisting dual leads
- Choose 33213 for generator insertion with an existing dual-lead system. Use 33221 when the existing pacing system has multiple leads.
- 33229Pacemaker replacementMultiple lead system
- 33229 describes removing and replacing a generator in a multiple-lead system. Code 33221 is for generator insertion without that removal-and-replacement service.
- 33208Pacemaker implantAtrial and ventricular leads
- 33208 describes implantation of a new atrial-and-ventricular pacing system. Code 33221 applies when multiple leads are already present and the service is generator insertion.
33221 billing questions
How is 33221 different from 33213?
33221 is for a generator connected to an existing multiple-lead system. Code 33213 is the generator-only choice for an existing dual-lead system.
Should 33221 be used when the generator is replaced?
Use the multiple-lead generator removal-and-replacement code, 33229, when the existing generator is removed and replaced. Code 33221 describes generator insertion rather than removal and replacement.
Does 33221 include placement of new leads?
It describes generator insertion with multiple leads already in place, not placement of new leads. The operative report should establish whether the leads were existing or newly implanted.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are other same-session procedures paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Assistant-at-surgery payment is statutorily restricted; co-surgeons and team surgery are 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
Fee sheets
Put 33221 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet