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CPT code 33228: Pacemaker generator exchange, dual-lead system2026 Medicare rate & RVUs

Report this service when a physician removes and replaces the pulse generator of an existing permanent pacemaker with a dual-lead configuration.

CMS RVU26DEffective Oct 1, 2026109 payment localities31.6K Medicare services in 2024

Medicare pays $315.30 for 33228 nationally in a facility.

Medicare rate · 33228

Pacemaker generator exchange, dual-lead system

Office or facility?

Work RVUs
5.38
Total RVUs
9.44
Global days
090

National rate · 2026

$315.30

Facility setting, before claim adjustments.

See every locality for 33228 →Billed by an NP, PA or therapist? →

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

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 33228 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 33228 covers

The physician removes a depleted or malfunctioning pulse generator from an existing permanent pacemaker system and connects a replacement while retaining the dual-lead configuration. A cardiologist or electrophysiologist typically performs the procedure in a cardiac catheterization or electrophysiology lab when the generator reaches battery end of service or needs replacement for another documented reason.

Select this code based on the existing system’s dual-lead configuration and an actual generator exchange, not on the number of leads newly implanted. The operative report should identify the existing system, generator removal and replacement, and lead configuration; generator removal is included in the exchange. CMS assigns a 90-day major-surgery global period, including 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%. Medicare 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.

Where 33228 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

33228 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$285.14
AlaskaUnavailable$391.99
ArizonaUnavailable$306.27
ArkansasUnavailable$281.48
Atlanta, GAUnavailable$325.92
Austin, TXUnavailable$316.18
Bakersfield, CAUnavailable$310.92
Baltimore area, MDUnavailable$335.09
Beaumont, TXUnavailable$303.91
Brazoria, TXUnavailable$306.50

33228 rates by state

Office rate range in each state. Select a state to see its payment localities.

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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
33228 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

How the 33228 rate is calculated

Each of 33228’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 · 33228

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.38

5.38 RVUs× 1.000 GPCI

Practice expense2.78

2.78 RVUs× 1.000 GPCI

Malpractice1.28

1.28 RVUs× 1.000 GPCI

Adjusted RVUs

9.4400

Conversion factor

$33.4009

Medicare rate

$315.30

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

Payment rules and modifiers for 33228

33228 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33228

Pacemaker generator exchange, dual-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 · 33228

Pacemaker generator exchange, dual-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

33228 without 51 · national facility

$315.30

Pacemaker generator exchange, dual-lead system

33228-51 · Second procedure: 50%

$157.65

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

33228 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 33228

    Pacemaker generator exchange, dual-lead system5.38 wRVU

    Not priced

  • 33227

    Pacemaker generator exchange, single-lead system5.12 wRVU

    Not priced

  • 33229

    Pacemaker replacement, multiple lead system5.65 wRVU

    Not priced

  • 33230

    ICD generator, existing dual leads5.92 wRVU

    Not priced

  • 33233

    Pacemaker generator removal, without replacement3.06 wRVU

    Not priced

How to choose

33227Pacemaker generator exchangeSingle-lead system
Use 33227 for exchange in a single-lead pacemaker system; 33228 is for an existing dual-lead system.
33229Pacemaker replacementMultiple lead system
Use 33229 for exchange in a multiple-lead pacemaker system. The dual-lead configuration points to 33228.
33230ICD generatorExisting dual leads
33230 describes insertion of a pulse generator with dual leads, rather than replacement of a generator in an existing dual-lead system.
33233Pacemaker generator removalWithout replacement
33233 is for generator removal without the replacement included in 33228.

Codes related to 33228

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 33228
CodeHow it relatesNational office range
Same family
33227Pacemaker generator exchange, single-lead systemGenerator exchange for an existing single-lead pacemaker system.No office rate
33229Pacemaker replacement, multiple lead systemGenerator exchange for an existing multiple-lead pacemaker system.No office rate
Used instead
33230ICD generator, existing dual leadsPulse-generator insertion with dual leads for a new system rather than generator exchange.No office rate
33233Pacemaker generator removal, without replacementGenerator removal when the generator is not replaced.No office rate

33228 billing questions

How does 33228 differ from the single- and multiple-lead exchange codes?

33228 is for exchange of a generator in an existing dual-lead system. Use 33227 for a single-lead system and 33229 for a system with multiple leads.

Can the generator removal be reported separately?

No. Removal of the existing generator is part of the exchange reported with 33228.

What documentation supports 33228?

The operative report should establish that the existing pacemaker generator was removed and replaced and identify the system as dual-lead.

Is 33228 used for a new dual-lead pacemaker implant?

No. It describes exchange of a generator in an existing system. Code 33230 describes insertion of a pulse generator with dual leads.

What Medicare surgical payment rules affect this service?

It has a 90-day global period, and same-session multiple procedures are subject to the standard reduction: the highest-valued procedure is paid in full and others at 50%. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 33228PPRRVU2026_Oct_nonQPP.csv, line 3,857 (RVU26D)

Open CMS sourceHow we calculate rates

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