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CPT code 33229: Pacemaker replacement, multiple lead system2026 Medicare rate & RVUs

Reports removal and replacement of a pacemaker pulse generator connected to a multiple-lead system, such as a pacemaker requiring generator exchange.

CMS RVU26DEffective Oct 1, 2026109 payment localities6.8K Medicare services in 2024

Medicare pays $329.67 for 33229 nationally in a facility.

Medicare rate · 33229

Pacemaker replacement, multiple lead system

Office or facility?

Work RVUs
5.65
Total RVUs
9.87
Global days
090

National rate · 2026

$329.67

Facility setting, before claim adjustments.

See every locality for 33229 →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 33229 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 33229 covers

During this procedure, the clinician opens the pacemaker pocket, disconnects and removes the existing pulse generator, and connects a replacement generator to the existing multiple-lead system. It is commonly performed by an electrophysiologist or other cardiac device specialist when a pacemaker generator reaches its replacement threshold, including because of battery depletion. The procedure may take place in a hospital or an ambulatory setting.

Select this code for a generator exchange in a multiple-lead pacemaker system; the number and type of leads, not the reason for replacement, distinguish it from single- and dual-lead generator replacement codes. The operative report should support removal of the old generator, placement of the replacement, and the multiple-lead system involved. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Medicare does not pay an assistant at surgery for this service; 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 33229 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

33229 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$298.32
AlaskaUnavailable$410.35
ArizonaUnavailable$320.28
ArkansasUnavailable$294.51
Atlanta, GAUnavailable$340.71
Austin, TXUnavailable$330.58
Bakersfield, CAUnavailable$325.15
Baltimore area, MDUnavailable$350.26
Beaumont, TXUnavailable$317.83
Brazoria, TXUnavailable$320.53

33229 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
33229 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 33229 rate is calculated

Each of 33229’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 · 33229

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.65

5.65 RVUs× 1.000 GPCI

Practice expense2.89

2.89 RVUs× 1.000 GPCI

Malpractice1.33

1.33 RVUs× 1.000 GPCI

Adjusted RVUs

9.8700

Conversion factor

$33.4009

Medicare rate

$329.67

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

Payment rules and modifiers for 33229

33229 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33229

Pacemaker replacement, multiple 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 · 33229

Pacemaker replacement, multiple 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

33229 without 51 · national facility

$329.67

Pacemaker replacement, multiple lead system

33229-51 · Second procedure: 50%

$164.84

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

33229 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 33229

    Pacemaker replacement, multiple lead system5.65 wRVU

    Not priced

  • 33227

    Pacemaker generator exchange, single-lead system5.12 wRVU

    Not priced

  • 33228

    Pacemaker generator exchange, dual-lead system5.38 wRVU

    Not priced

  • 33231

    Defibrillator generator, multiple existing leads6.18 wRVU

    Not priced

  • 33264

    ICD generator replacement, multiple lead system6.19 wRVU

    Not priced

How to choose

33227Pacemaker generator exchangeSingle-lead system
Use 33227 for generator replacement in a single-lead pacemaker system; this code is for a multiple-lead system.
33228Pacemaker generator exchangeDual-lead system
Use 33228 for a dual-lead system. This code applies when the pacemaker system has multiple leads.
33231Defibrillator generatorMultiple existing leads
33231 describes generator insertion with a multiple-lead system. This code describes removing an existing generator and replacing it.
33264ICD generator replacementMultiple lead system
33264 is for ICD generator removal and replacement in a multiple-lead system; this code is for a pacemaker generator.

Codes related to 33229

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

Codes related to 33229
CodeHow it relatesNational office range
Same family
33227Pacemaker generator exchange, single-lead systemGenerator replacement sibling for a single-lead pacemaker system.No office rate
33228Pacemaker generator exchange, dual-lead systemGenerator replacement sibling for a dual-lead pacemaker system.No office rate
Used instead
33231Defibrillator generator, multiple existing leadsGenerator insertion with a multiple-lead system, rather than removal and replacement of an existing generator.No office rate
33233Pacemaker generator removal, without replacementRemoval of a pacemaker generator when replacement is not performed.No office rate
33264ICD generator replacement, multiple lead systemRemoval and replacement of an ICD generator in a multiple-lead system.No office rate

33229 billing questions

How is this code distinguished from the single- and dual-lead replacement codes?

Choose based on the pacemaker system’s lead configuration: this code is for a multiple-lead system, while 33227 and 33228 represent single- and dual-lead systems.

Does this code include replacement of the pacing leads?

It describes exchange of the pulse generator connected to the existing multiple-lead system. Lead insertion, repositioning, or repair is a different service and should be supported and coded separately when performed.

Can this code be used for an ICD generator exchange?

No. This code is for a pacemaker generator; an ICD generator replacement belongs to the ICD procedure code family.

What postoperative care is included in the global period?

The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.

How does Medicare handle another procedure performed in the same session?

The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple procedure reduction.

Can an assistant or co-surgeon be reported for this procedure?

Medicare does not pay an assistant at surgery for this service. 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
RVUs for 33229PPRRVU2026_Oct_nonQPP.csv, line 3,858 (RVU26D)

Open CMS sourceHow we calculate rates

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