CPT code 33227: Pacemaker generator exchange, single-lead system2026 Medicare rate & RVUs in Arkansas

Report this service when a physician removes and replaces a permanent pacemaker generator while retaining the existing single-lead pacing system.

CMS RVU26DEffective Oct 1, 2026One payment locality2.1K Medicare services in 2024

In Arkansas, Medicare pays $269.58 for 33227 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$269.58Hospital or facility

Check a contract rate as a % of Medicare · 33227 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 33227 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Arkansas
  2. What 33227 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 33227 covers

An electrophysiologist or other qualified physician opens the pacemaker pocket, disconnects the depleted or malfunctioning pulse generator from the existing pacing lead, attaches a replacement generator, and closes the pocket. This exchange is commonly performed in a hospital or outpatient facility when the generator reaches its replacement point or fails; the existing single-lead system remains in place.

Select the code based on the pacemaker system’s lead count, not simply the generator’s age or the reason for exchange. Documentation should identify the existing single-lead system, the generator removed and implanted, and the reason for replacement. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this single-generator service. CMS does not pay an assistant at surgery; 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.

How Arkansas compares for 33227

Across 109 of 109 payment localities, the facility rate for 33227 runs from $269.58 in Arkansas to $375.19 in Alaska. Arkansas pays $269.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

33227 in Arkansas vs other payment areas
  1. Arkansas · this page$269.58
  2. Los Angeles, CA · California$311.94+$42.36
  3. Washington, DC area · District of Columbia$331.86+$62.28
  4. Miami, FL · Florida$367.45+$97.87
  5. Chicago, IL · Illinois$355.93+$86.35
  6. Manhattan, NY · New York$351.24+$81.66
  7. Alaska · Alaska$375.19+$105.61

Other areas in Arkansas first, then benchmark localities. Bars start at $0.

Every other payment area

33227 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama—$273.09
ArizonaArizona—$293.32
Bakersfield, CACalifornia—$298.08
Chico, CACalifornia—$294.79
El Centro, CACalifornia—$294.99
Fresno, CACalifornia—$294.79
Hanford, CACalifornia—$294.79
Madera, CACalifornia—$294.79

33227 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
33227 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

See 33227 in every payment locality

How the 33227 rate is calculated

Each of 33227’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 · 33227

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.12

5.12 RVUs× 1.000 GPCI

Practice expense2.71

2.71 RVUs× 1.000 GPCI

Malpractice1.21

1.21 RVUs× 1.000 GPCI

Adjusted RVUs

9.0400

Conversion factor

$33.4009

Medicare rate

$301.94

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Arkansas inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,856

Code
33227
Physician work
5.12
Practice expense
2.71
Malpractice
1.21

GPCI2026.csv

7

Locality
Arkansas
Physician work
1.000
Practice expense
0.859
Malpractice
0.515
Facility calculation for 33227 in Arkansas
ComponentRVULocality factorAdjusted
Physician work5.12× 1.0005.1200
Practice expense2.71× 0.8592.3279
Malpractice1.21× 0.5150.6231
Total RVUs8.0710
Conversion factor× 33.4009

Facility rate, Arkansas$269.58

Facility: (5.12 × 1 + 2.71 × 0.859 + 1.21 × 0.515) × $33.4009 = $269.58

Open 33227 in the RVU calculator

Payment rules and modifiers for 33227

33227 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33227

Pacemaker generator exchange, single-lead system

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 33227

Pacemaker generator exchange, single-lead system

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

33227 without 51 · national facility

$301.94

Pacemaker generator exchange, single-lead system

33227-51 · Second procedure: 50%

$150.97

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%).

When to use modifier 51

How 33227 has changed in Arkansas

33227 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

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
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$269.58RVU26D
2026-07-01Not available in this setting$269.58RVU26C
2026-04-01Not available in this setting$269.58RVU26B
2026-01-01Not available in this setting$269.58RVU26A
2025-10-01Not available in this setting$290.29RVU25D
2025-07-01Not available in this setting$290.29RVU25C
2025-04-01Not available in this setting$290.29RVU25B
2025-01-01Not available in this setting$290.29RVU25A
2024-10-01Not available in this setting$297.82RVU24D
2024-07-01Not available in this setting$297.82RVU24C
2024-04-01Not available in this setting$297.82RVU24B
2024-03-09Not available in this setting$297.82RVU24AR
2024-01-01Not available in this setting$292.96RVU24A
2023-10-01Not available in this setting$302.05RVU23D
2023-07-01Not available in this setting$302.05RVU23C
2023-04-01Not available in this setting$302.05RVU23B
2023-01-01Not available in this setting$302.05RVU23A
2022-10-01Not available in this setting$306.81RVU22D
2022-07-01Not available in this setting$306.81RVU22C
2022-04-01Not available in this setting$306.81RVU22B
2022-01-01Not available in this setting$306.81RVU22A
2021-10-01Not available in this setting$307.39RVU21D
2021-07-01Not available in this setting$307.39RVU21C
2021-04-01Not available in this setting$307.39RVU21B
2021-01-01Not available in this setting$307.39RVU21A
2020-10-01Not available in this setting$316.87RVU20D
2020-07-01Not available in this setting$316.87RVU20C
2020-04-01Not available in this setting$316.87RVU20B
2020-01-01Not available in this setting$316.87RVU20A
2019-10-01Not available in this setting$319.81RVU19D
2019-07-01Not available in this setting$319.81RVU19C
2019-04-01Not available in this setting$319.81RVU19B
2019-01-01Not available in this setting$319.81RVU19A
2018-10-01Not available in this setting$319.25RVU18D
2018-07-01Not available in this setting$319.25RVU18C
2018-04-01Not available in this setting$319.25RVU18B
2018-01-01Not available in this setting$319.25RVU18AR1
2017-10-01Not available in this setting$316.49RVU17D
2017-07-01Not available in this setting$316.49RVU17C
2017-04-01Not available in this setting$316.49RVU17B
2017-01-01Not available in this setting$316.49RVU17A
2016-10-01Not available in this setting$326.32RVU16D
2016-07-01Not available in this setting$326.32RVU16C
2016-04-01Not available in this setting$326.32RVU16B
2016-01-01Not available in this setting$326.32RVU16A
2015-10-01Not available in this setting$327.31RVU15D
2015-07-01Not available in this setting$327.31RVU15C
2015-04-01Not available in this setting$325.68RVU15B
2015-01-01Not available in this setting$325.68RVU15A
2014-10-01Not available in this setting$321.75RVU14D
2014-07-01Not available in this setting$321.75RVU14C
2014-04-01Not available in this setting$321.75RVU14B
2014-01-01Not available in this setting$321.75RVU14A
2013-10-01Not available in this setting$308.96RVU13D
2013-07-01Not available in this setting$308.96RVU13C
2013-04-01Not available in this setting$308.96RVU13B
2013-01-01Not available in this setting$308.96RVU13AR

Price 33227 for an earlier date of service

Where the Arkansas rate applies

Arkansas is a Medicare payment area, not a city. Our Census mapping connects it to 626 cities and communities in Arkansas. Some span more than one payment area; confirm with the service ZIP.

  • Acorn
  • Adona
  • Alexander
  • Alicia
  • Alix
  • Alleene
  • Allport
  • Alma

Browse all communities in Arkansas

33227 billing questions

How is this code distinguished from 33228?

Use 33227 for replacement of a generator in a single-lead pacemaker system. Code 33228 is for a dual-lead system.

Is removal of the old generator included?

Yes. The service includes removing the existing generator as part of the exchange; do not separately report generator removal for that same exchange.

What documentation supports the single-lead selection?

Document the pacemaker configuration and the lead count, along with the generator removed, replacement generator, and reason for the exchange.

Should modifier 50 be reported?

No. Modifier 50 is inappropriate for this single-generator exchange.

Can an assistant or co-surgeon be reported?

CMS does not pay an assistant at surgery for this code. Co-surgeon and team-surgery reporting 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
RVUs for 33227PPRRVU2026_Oct_nonQPP.csv, line 3,856 (RVU26D)
Geographic factors for ArkansasGPCI2026.csv, line 7 (RVU26D)

Open CMS sourceHow we calculate rates

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