CPT code 33238: Pacing lead removal, thoracotomy approach2026 Medicare rate & RVUs in Missouri
Reports surgical removal of a permanent pacing electrode through a thoracotomy, rather than extraction of a pacemaker lead through the venous route.
CMS doesn’t publish an office rate for 33238 in Missouri.
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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What 33238 covers
This service removes a permanent pacemaker electrode through an open chest approach. It is generally performed by a cardiac surgeon when the lead is accessible from the chest or cannot be removed using a transvenous extraction approach. The work concerns the pacing electrode, not simply removal of the pulse generator. The procedure is typically performed in a hospital operating room.
Report 33238 when the documented lead-removal procedure matches this thoracotomy-based service; distinguish it from transvenous pacemaker lead extraction and from removal of implantable defibrillator electrodes. The operative report should identify the device and electrode removed, the surgical approach, and the reason for removal. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is not appropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons are permitted, while team surgery is 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 33238 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $915.23 |
| Metropolitan St. Louis, MO | Unavailable | $922.34 |
| Rest of Missouri | Unavailable | $890.59 |
How the 33238 rate is calculated
Each of 33238’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 · 33238
RVUs × geographic indexes × conversion factor
Work15.02
15.02 RVUs× 1.000 GPCI
Practice expense9.44
9.44 RVUs× 1.000 GPCI
Malpractice3.60
3.60 RVUs× 1.000 GPCI
Adjusted RVUs
28.0600
Conversion factor
$33.4009
Medicare rate
$937.23
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33238
33238 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33238
Pacing lead removal, thoracotomy approach
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 2 | 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 · 33238
Pacing lead removal, thoracotomy approach
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
33238 without 51 · national facility
$937.23
Pacing lead removal, thoracotomy approach
33238-51 · Second procedure: 50%
$468.62
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%).
33238 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33234Pacemaker lead removalSingle-lead transvenous system
- 33234 is for transvenous removal of a pacemaker electrode in a single-lead system. Use 33238 for the thoracotomy-based removal service.
- 33235Pacemaker lead removalDual-lead system
- 33235 describes transvenous pacemaker electrode removal in a dual-lead system; 33238 describes removal through a thoracotomy.
- 33243ICD lead removalBy thoracotomy
- 33243 is for thoracotomy-based removal of implantable defibrillator electrode(s). 33238 is the related pacing-electrode service.
- 33244ICD lead extractionTransvenous approach
- 33244 removes implantable defibrillator electrode(s) transvenously. The device type and surgical approach distinguish it from 33238.
33238 billing questions
How does 33238 differ from transvenous pacemaker lead removal?
33238 describes removal through a thoracotomy. Codes 33234 and 33235 describe transvenous removal of pacemaker electrodes, with the applicable code depending on the lead system.
Is 33238 for the generator or the electrode?
It is for electrode removal. Do not use it for removal of a pulse generator alone.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this service; report the procedure without a bilateral adjustment.
When can an assistant surgeon be paid?
Assistant-at-surgery payment is available only when the record documents medical necessity for the assistant.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care.
Can co-surgeons report this procedure?
Co-surgeons are permitted. Team surgery is not permitted for this code.
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
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