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CPT code 33235: Pacemaker lead removal, dual-lead system2026 Medicare rate & RVUs

Reports transvenous removal of electrode leads from a dual-lead pacemaker system, such as for infection, lead malfunction, or access for a new lead.

CMS RVU26DEffective Oct 1, 2026109 payment localities4K Medicare services in 2024

Medicare pays $567.82 for 33235 nationally in a facility.

Medicare rate · 33235

Pacemaker lead removal, dual-lead system

Office or facility?

Work RVUs
9.65
Total RVUs
17.00
Global days
090

National rate · 2026

$567.82

Facility setting, before claim adjustments.

See every locality for 33235 →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 33235 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 33235 covers

33235 represents transvenous removal of electrode leads from a permanent pacemaker system configured with two leads. Electrophysiologists and cardiac surgeons commonly perform the procedure in a hospital facility when a lead is infected, damaged, malfunctioning, or must be removed to make room for a new lead. Lead extraction may involve specialized tools when simple traction is not sufficient.

Choose this code for a dual-lead pacemaker system; 33234 describes a single-lead system. Document the implanted system configuration, the lead or leads removed, the transvenous approach, and the clinical reason for removal. Report pacemaker generator removal separately when performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery, and 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 33235 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

33235 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$513.60
AlaskaUnavailable$705.79
ArizonaUnavailable$551.60
ArkansasUnavailable$507.00
Atlanta, GAUnavailable$586.80
Austin, TXUnavailable$569.60
Bakersfield, CAUnavailable$560.42
Baltimore area, MDUnavailable$603.38
Beaumont, TXUnavailable$547.17
Brazoria, TXUnavailable$552.12

33235 rates by state

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

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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
33235 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 33235 rate is calculated

Each of 33235’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 · 33235

RVUs × geographic indexes × conversion factor

Office or facility?

Work9.65

9.65 RVUs× 1.000 GPCI

Practice expense5.07

5.07 RVUs× 1.000 GPCI

Malpractice2.28

2.28 RVUs× 1.000 GPCI

Adjusted RVUs

17.0000

Conversion factor

$33.4009

Medicare rate

$567.82

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

Payment rules and modifiers for 33235

33235 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33235

Pacemaker lead removal, 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 · 33235

Pacemaker lead removal, 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

33235 without 51 · national facility

$567.82

Pacemaker lead removal, dual-lead system

33235-51 · Second procedure: 50%

$283.91

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

33235 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 33235

    Pacemaker lead removal, dual-lead system9.65 wRVU

    Not priced

  • 33234

    Pacemaker lead removal, single-lead transvenous system7.47 wRVU

    Not priced

  • 33236

    Lead removal, thoracotomy approach12.41 wRVU

    Not priced

  • 33233

    Pacemaker generator removal, without replacement3.06 wRVU

    Not priced

  • 33244

    ICD lead extraction, transvenous approach13.4 wRVU

    Not priced

How to choose

33234Pacemaker lead removalSingle-lead transvenous system
Use 33234 for lead removal from a single-lead pacemaker system. Use 33235 for a dual-lead system.
33236Lead removalThoracotomy approach
33236 describes pacemaker electrode removal by thoracotomy. 33235 is for transvenous removal.
33233Pacemaker generator removalWithout replacement
33233 is for removal of the pacemaker generator, not its electrode leads. Generator removal may be reported separately when both services are performed.
33244ICD lead extractionTransvenous approach
33244 is for transvenous removal of defibrillator leads. 33235 applies to leads in a pacemaker system.

Codes related to 33235

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

Codes related to 33235
CodeHow it relatesNational office range
Same family
33234Pacemaker lead removal, single-lead transvenous systemRemoval of transvenous pacemaker leads from a single-lead system.No office rate
Often billed with
33233Pacemaker generator removal, without replacementPacemaker generator removal may be separately reported when performed in the same session.No office rate
Used instead
33236Lead removal, thoracotomy approachPacemaker electrode removal by thoracotomy rather than the transvenous approach.No office rate
33244ICD lead extraction, transvenous approachTransvenous removal of defibrillator leads, rather than pacemaker leads.No office rate

33235 billing questions

How does 33235 differ from 33234?

33235 is for lead removal from a dual-lead pacemaker system; 33234 is for a single-lead system. Base the selection on the system configuration.

Can pacemaker generator removal be reported separately?

Yes. When the generator is also removed, report the applicable generator-removal code separately from 33235.

Should modifier 50 be used when both leads are removed?

No. Modifier 50 is inappropriate for this code, even when leads on both sides of the system are removed.

What documentation supports 33235?

Document that the implanted pacemaker is a dual-lead system, which lead or leads were removed, the transvenous approach, and the reason for removal.

Can an assistant surgeon or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this code, and co-surgeons 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 33235PPRRVU2026_Oct_nonQPP.csv, line 3,864 (RVU26D)

Open CMS sourceHow we calculate rates

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