CPT code 33229: Pacemaker replacement, multiple lead system2026 Medicare rate & RVUs in California
Reports removal and replacement of a pacemaker pulse generator connected to a multiple-lead system, such as a pacemaker requiring generator exchange.
CMS doesn’t publish an office rate for 33229 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.
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On this page 9 sections
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 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 | $325.15 |
| Chico, CA | Unavailable | $321.53 |
| El Centro, CA | Unavailable | $321.75 |
| Fresno, CA | Unavailable | $321.53 |
| Hanford, CA | Unavailable | $321.53 |
| Los Angeles, CA | Unavailable | $340.14 |
| Madera, CA | Unavailable | $321.53 |
| Marin County, CA | Unavailable | $363.14 |
| Merced, CA | Unavailable | $321.53 |
| Modesto, CA | Unavailable | $321.53 |
| Napa, CA | Unavailable | $350.40 |
| Oxnard, CA | Unavailable | $335.77 |
| Redding, CA | Unavailable | $321.53 |
| Rest of California | Unavailable | $321.53 |
| Riverside, CA | Unavailable | $335.80 |
| Sacramento, CA | Unavailable | $331.58 |
| Salinas, CA | Unavailable | $330.25 |
| San Benito County, CA | Unavailable | $372.48 |
| San Diego, CA | Unavailable | $333.90 |
| San Francisco, CA | Unavailable | $361.63 |
| San Luis Obispo, CA | Unavailable | $325.68 |
| Santa Clara County, CA | Unavailable | $366.30 |
| Santa Cruz, CA | Unavailable | $333.77 |
| Santa Maria, CA | Unavailable | $330.36 |
| Santa Rosa, CA | Unavailable | $336.72 |
| Stockton, CA | Unavailable | $321.53 |
| Vallejo, CA | Unavailable | $348.22 |
| Visalia, CA | Unavailable | $321.53 |
| Yuba City, CA | Unavailable | $321.53 |
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
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
| 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 · 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.
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%).
33229 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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