CPT code 33225: LV pacing lead, add-on with generator procedure2026 Medicare rate & RVUs in Puerto Rico
Reports placement of a left ventricular pacing lead in the cardiac venous system as an add-on during a qualifying pacemaker or defibrillator procedure.
In Puerto Rico, Medicare pays $394.16 for 33225 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 33225 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 33225 covers
An electrophysiologist or other physician who implants cardiac devices places a lead through the cardiac venous system to pace the left ventricle, commonly as part of a cardiac resynchronization therapy system. The lead is generally positioned through the coronary sinus and connected as part of a pacemaker or implantable defibrillator procedure in an electrophysiology or cardiac catheterization lab.
Report 33225 only with an eligible primary procedure; it is not a stand-alone service. The operative report should support placement of the left ventricular pacing lead and identify the related generator procedure. CMS treats this as an add-on code, paid within the primary procedure's global period. The primary procedure establishes the applicable global period, so the lead service is not reported as a separate primary procedure.
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 Puerto Rico compares for 33225
Across 109 of 109 payment localities, the facility rate for 33225 runs from $347.82 in Wisconsin to $505.29 in Alaska. Puerto Rico pays $394.16. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$394.16
- Los Angeles, CA · California$395.03+$0.87
- Washington, DC area · District of Columbia$426.90+$32.74
- Miami, FL · Florida$494.45+$100.29
- Chicago, IL · Illinois$479.28+$85.12
- Manhattan, NY · New York$458.84+$64.68
- Alaska · Alaska$505.29+$111.13
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $359.35 |
| ArkansasArkansas | — | $355.14 |
| ArizonaArizona | — | $383.43 |
| Bakersfield, CACalifornia | — | $380.38 |
| Chico, CACalifornia | — | $375.18 |
| El Centro, CACalifornia | — | $375.50 |
| Fresno, CACalifornia | — | $375.18 |
| Hanford, CACalifornia | — | $375.18 |
| Madera, CACalifornia | — | $375.18 |
| Merced, CACalifornia | — | $375.18 |
| Modesto, CACalifornia | — | $375.18 |
| Napa, CACalifornia | — | $399.07 |
| Oxnard, CACalifornia | — | $388.83 |
| Redding, CACalifornia | — | $375.18 |
| Rest of CaliforniaCalifornia | — | $375.18 |
| Riverside, CACalifornia | — | $395.68 |
| Sacramento, CACalifornia | — | $384.32 |
| Salinas, CACalifornia | — | $382.72 |
| San Diego, CACalifornia | — | $385.04 |
| Marin County, CACalifornia | — | $410.09 |
| San Francisco, CACalifornia | — | $407.92 |
| San Benito County, CACalifornia | — | $420.98 |
| Santa Clara County, CACalifornia | — | $412.11 |
| San Luis Obispo, CACalifornia | — | $377.74 |
| Santa Cruz, CACalifornia | — | $383.34 |
| Santa Maria, CACalifornia | — | $382.33 |
| Santa Rosa, CACalifornia | — | $386.56 |
| Stockton, CACalifornia | — | $375.18 |
| Vallejo, CACalifornia | — | $395.94 |
| Visalia, CACalifornia | — | $375.18 |
| Yuba City, CACalifornia | — | $375.18 |
| ColoradoColorado | — | $387.55 |
| ConnecticutConnecticut | — | $417.86 |
| DelawareDelaware | — | $388.66 |
| Fort Lauderdale, FLFlorida | — | $446.78 |
| Rest of FloridaFlorida | — | $423.94 |
| Atlanta, GAGeorgia | — | $409.05 |
| Rest of GeorgiaGeorgia | — | $400.29 |
| Hawaii, Guam, HIHawaii | — | $375.75 |
| IowaIowa | — | $350.94 |
| IdahoIdaho | — | $356.09 |
| East St. Louis, ILIllinois | — | $454.40 |
| Rest of IllinoisIllinois | — | $425.21 |
| Suburban Chicago, ILIllinois | — | $447.22 |
| IndianaIndiana | — | $357.33 |
| KansasKansas | — | $357.11 |
| KentuckyKentucky | — | $382.44 |
| New Orleans, LALouisiana | — | $399.63 |
| Rest of LouisianaLouisiana | — | $384.95 |
| Metropolitan Boston, MAMassachusetts | — | $410.10 |
| Rest of MassachusettsMassachusetts | — | $389.00 |
| Baltimore area, MDMaryland | — | $418.26 |
| Rest of MarylandMaryland | — | $392.66 |
| Rest of MaineMaine | — | $365.59 |
| Southern Maine, MEMaine | — | $370.39 |
| Detroit, MIMichigan | — | $436.15 |
| Rest of MichiganMichigan | — | $397.52 |
| MinnesotaMinnesota | — | $351.28 |
| Metropolitan Kansas City, MOMissouri | — | $389.37 |
| Metropolitan St. Louis, MOMissouri | — | $391.74 |
| Rest of MissouriMissouri | — | $384.60 |
| MississippiMississippi | — | $369.55 |
| MontanaMontana | — | $394.34 |
| North CarolinaNorth Carolina | — | $367.45 |
| North DakotaNorth Dakota | — | $356.57 |
| NebraskaNebraska | — | $350.21 |
| New HampshireNew Hampshire | — | $388.93 |
| Northern New JerseyNew Jersey | — | $425.40 |
| Rest of New JerseyNew Jersey | — | $416.97 |
| New MexicoNew Mexico | — | $402.35 |
| NevadaNevada | — | $383.87 |
| NYC suburbs and Long Island, NYNew York | — | $477.73 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $425.71 |
| Queens, NYNew York | — | $450.84 |
| Rest of New YorkNew York | — | $372.54 |
| OhioOhio | — | $389.80 |
| OklahomaOklahoma | — | $373.88 |
| Portland, OROregon | — | $389.07 |
| Rest of OregonOregon | — | $375.28 |
| Metropolitan Philadelphia, PAPennsylvania | — | $414.10 |
| Rest of PennsylvaniaPennsylvania | — | $386.08 |
| Rhode IslandRhode Island | — | $394.69 |
| South CarolinaSouth Carolina | — | $380.38 |
| South DakotaSouth Dakota | — | $352.10 |
| TennesseeTennessee | — | $359.52 |
| Austin, TXTexas | — | $391.18 |
| Beaumont, TXTexas | — | $384.58 |
| Brazoria, TXTexas | — | $382.06 |
| Dallas, TXTexas | — | $387.61 |
| Fort Worth, TXTexas | — | $387.84 |
| Galveston, TXTexas | — | $385.25 |
| Houston, TXTexas | — | $420.21 |
| Rest of TexasTexas | — | $385.24 |
| UtahUtah | — | $384.39 |
| VirginiaVirginia | — | $374.70 |
| Virgin Islands, VIUnited States Virgin Islands | — | $394.16 |
| VermontVermont | — | $362.36 |
| Rest of WashingtonWashington | — | $385.89 |
| King County, WAWashington | — | $409.85 |
| WisconsinWisconsin | — | $347.82 |
| West VirginiaWest Virginia | — | $414.17 |
| WyomingWyoming | — | $377.88 |
33225 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 33225 rate is calculated
Each of 33225’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 · 33225
RVUs × geographic indexes × conversion factor
Work8.12
8.12 RVUs× 1.000 GPCI
Practice expense1.78
1.78 RVUs× 1.000 GPCI
Malpractice1.91
1.91 RVUs× 1.000 GPCI
Adjusted RVUs
11.8100
Conversion factor
$33.4009
Medicare rate
$394.46
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
3,854
- Code
- 33225
- Physician work
- 8.12
- Practice expense
- 1.78
- Malpractice
- 1.91
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.12 | × 1.000 | 8.1200 |
| Practice expense | 1.78 | × 1.011 | 1.7996 |
| Malpractice | 1.91 | × 0.985 | 1.8813 |
| Total RVUs | 11.8009 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Puerto Rico$394.16
Facility: (8.12 × 1 + 1.78 × 1.011 + 1.91 × 0.985) × $33.4009 = $394.16
Payment rules and modifiers for 33225
The CMS indicators that decide how 33225 is paid alongside other services.
CMS payment indicators · 33225
LV pacing lead, add-on with generator procedure
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
How 33225 has changed in Puerto Rico
33225 · 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 | $394.16 | RVU26D |
| 2026-07-01 | Not available in this setting | $394.16 | RVU26C |
| 2026-04-01 | Not available in this setting | $394.16 | RVU26B |
| 2026-01-01 | Not available in this setting | $394.16 | RVU26A |
| 2025-10-01 | Not available in this setting | $438.27 | RVU25D |
| 2025-07-01 | Not available in this setting | $438.27 | RVU25C |
| 2025-04-01 | Not available in this setting | $438.27 | RVU25B |
| 2025-01-01 | Not available in this setting | $438.27 | RVU25A |
| 2024-10-01 | Not available in this setting | $449.35 | RVU24D |
| 2024-07-01 | Not available in this setting | $449.35 | RVU24C |
| 2024-04-01 | Not available in this setting | $449.35 | RVU24B |
| 2024-03-09 | Not available in this setting | $449.35 | RVU24AR |
| 2024-01-01 | Not available in this setting | $442.01 | RVU24A |
| 2023-10-01 | Not available in this setting | $462.83 | RVU23D |
| 2023-07-01 | Not available in this setting | $462.90 | RVU23C |
| 2023-04-01 | Not available in this setting | $462.90 | RVU23B |
| 2023-01-01 | Not available in this setting | $462.90 | RVU23A |
| 2022-10-01 | Not available in this setting | $476.91 | RVU22D |
| 2022-07-01 | Not available in this setting | $476.91 | RVU22C |
| 2022-04-01 | Not available in this setting | $476.91 | RVU22B |
| 2022-01-01 | Not available in this setting | $476.91 | RVU22A |
| 2021-10-01 | Not available in this setting | $478.82 | RVU21D |
| 2021-07-01 | Not available in this setting | $478.82 | RVU21C |
| 2021-04-01 | Not available in this setting | $478.82 | RVU21B |
| 2021-01-01 | Not available in this setting | $478.82 | RVU21A |
| 2020-10-01 | Not available in this setting | $492.82 | RVU20D |
| 2020-07-01 | Not available in this setting | $492.82 | RVU20C |
| 2020-04-01 | Not available in this setting | $492.82 | RVU20B |
| 2020-01-01 | Not available in this setting | $492.82 | RVU20A |
| 2019-10-01 | Not available in this setting | $492.83 | RVU19D |
| 2019-07-01 | Not available in this setting | $492.83 | RVU19C |
| 2019-04-01 | Not available in this setting | $492.83 | RVU19B |
| 2019-01-01 | Not available in this setting | $492.83 | RVU19A |
| 2018-10-01 | Not available in this setting | $492.30 | RVU18D |
| 2018-07-01 | Not available in this setting | $492.30 | RVU18C |
| 2018-04-01 | Not available in this setting | $492.30 | RVU18B |
| 2018-01-01 | Not available in this setting | $492.30 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $448.79 | RVU17D |
| 2017-07-01 | Not available in this setting | $448.79 | RVU17C |
| 2017-04-01 | Not available in this setting | $448.79 | RVU17B |
| 2017-01-01 | Not available in this setting | $448.79 | RVU17A |
| 2016-10-01 | Not available in this setting | $402.41 | RVU16D |
| 2016-07-01 | Not available in this setting | $402.41 | RVU16C |
| 2016-04-01 | Not available in this setting | $402.41 | RVU16B |
| 2016-01-01 | Not available in this setting | $402.41 | RVU16A |
| 2015-10-01 | Not available in this setting | $403.54 | RVU15D |
| 2015-07-01 | Not available in this setting | $403.54 | RVU15C |
| 2015-04-01 | Not available in this setting | $401.53 | RVU15B |
| 2015-01-01 | Not available in this setting | $401.53 | RVU15A |
| 2014-10-01 | Not available in this setting | $396.36 | RVU14D |
| 2014-07-01 | Not available in this setting | $396.36 | RVU14C |
| 2014-04-01 | Not available in this setting | $396.36 | RVU14B |
| 2014-01-01 | Not available in this setting | $396.36 | RVU14A |
| 2013-10-01 | Not available in this setting | $374.03 | RVU13D |
| 2013-07-01 | Not available in this setting | $374.03 | RVU13C |
| 2013-04-01 | Not available in this setting | $374.03 | RVU13B |
| 2013-01-01 | Not available in this setting | $374.03 | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
33225 billing questions
Can 33225 be reported by itself?
No. It is an add-on for left ventricular lead placement performed with an eligible primary pacemaker or defibrillator procedure.
What distinguishes 33225 from 33226?
33225 reports placement of a left ventricular pacing lead with a qualifying primary procedure. Code 33226 is for repositioning an existing left ventricular lead.
What documentation supports 33225?
The operative report should describe placement of the left ventricular lead in the cardiac venous system and identify the primary generator procedure performed.
Is 33225 reported with a pacemaker or a defibrillator procedure?
It may accompany an eligible primary procedure for either type of device. The documentation must support the lead placement and the related primary procedure.
How does 33225 differ from 33224?
Both concern left ventricular pacing leads, but 33225 is specifically an add-on reported with a primary procedure. Select 33224 for the distinct lead service it describes, based on the procedure performed.
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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