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CPT code 33274: Leadless pacemaker, right ventricular insertion or replacement2026 Medicare rate & RVUs

Report this service when a clinician places or replaces a permanent leadless pacemaker in the right ventricle using a transcatheter approach.

CMS RVU26DEffective Oct 1, 2026109 payment localities15.4K Medicare services in 2024

Medicare pays $419.52 for 33274 nationally in a facility.

Medicare rate · 33274

Leadless pacemaker, right ventricular insertion or replacement

Office or facility?

Work RVUs
7.61
Total RVUs
12.56
Global days
090

National rate · 2026

$419.52

Facility setting, before claim adjustments.

See every locality for 33274 →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 33274 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 33274 covers

An electrophysiologist or other qualified cardiac specialist delivers a permanent, self-contained pacing device through a catheter into the right ventricle, typically through venous access in a hospital electrophysiology or catheterization lab. Unlike a conventional pacemaker, the leadless device sits inside the heart and does not use a chest pocket or transvenous pacing lead. The service includes imaging guidance and device evaluation associated with placement or replacement.

Select this code for right-ventricular leadless device insertion or replacement, not for a conventional transvenous pacemaker or a subcutaneous defibrillator. Document the clinical indication, transcatheter placement or replacement, device location, and evaluation. If an existing leadless device is removed during replacement, report the removal service separately when performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeons are permitted, but team surgery is not.

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 33274 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

33274 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$380.58
AlaskaUnavailable$526.96
ArizonaUnavailable$407.71
ArkansasUnavailable$375.87
Atlanta, GAUnavailable$433.86
Austin, TXUnavailable$419.44
Bakersfield, CAUnavailable$411.43
Baltimore area, MDUnavailable$445.35
Beaumont, TXUnavailable$405.76
Brazoria, TXUnavailable$407.59

33274 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
33274 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 33274 rate is calculated

Each of 33274’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 · 33274

RVUs × geographic indexes × conversion factor

Office or facility?

Work7.61

7.61 RVUs× 1.000 GPCI

Practice expense3.18

3.18 RVUs× 1.000 GPCI

Malpractice1.77

1.77 RVUs× 1.000 GPCI

Adjusted RVUs

12.5600

Conversion factor

$33.4009

Medicare rate

$419.52

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

Payment rules and modifiers for 33274

33274 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33274

Leadless pacemaker, right ventricular insertion or replacement

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)2Permitted.
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 · 33274

Leadless pacemaker, right ventricular insertion or replacement

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

33274 without 51 · national facility

$419.52

Leadless pacemaker, right ventricular insertion or replacement

33274-51 · Second procedure: 50%

$209.76

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

33274 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 33274

    Leadless pacemaker, right ventricular insertion or replacement7.61 wRVU

    Not priced

  • 33275

    Pacemaker removal, leadless device8.38 wRVU

    Not priced

  • 33207

    Pacemaker insertion, ventricular-only system7.61 wRVU

    Not priced

  • 33208

    Pacemaker implant, atrial and ventricular leads8.31 wRVU

    Not priced

  • 33262

    Defibrillator exchange, single-lead system5.66 wRVU

    Not priced

How to choose

33275Pacemaker removalLeadless device
33275 describes transcatheter removal of a permanent leadless pacemaker. Use it for extraction; 33274 covers placement or replacement of the right-ventricular leadless device.
33207Pacemaker insertionVentricular-only system
33207 is for a conventional ventricular pacemaker system with a transvenous electrode. Choose 33274 when the pacing device is leadless and placed in the right ventricle by catheter.
33208Pacemaker implantAtrial and ventricular leads
33208 describes a conventional dual-chamber pacemaker system using transvenous electrodes. It is not the code for a single leadless device placed in the right ventricle.
33262Defibrillator exchangeSingle-lead system
33262 reports generator removal and replacement in a single-lead pacing system. It does not describe transcatheter insertion or replacement of a leadless pacemaker.

Codes related to 33274

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

Codes related to 33274
CodeHow it relatesNational office range
Often billed with
33275Pacemaker removal, leadless deviceSeparately reports transcatheter removal when an existing leadless pacemaker is extracted during replacement.No office rate
Used instead
33207Pacemaker insertion, ventricular-only systemDescribes a conventional ventricular pacemaker system using a transvenous electrode.No office rate
33208Pacemaker implant, atrial and ventricular leadsDescribes a conventional dual-chamber pacemaker system with transvenous electrodes.No office rate
33262Defibrillator exchange, single-lead systemApplies to generator removal and replacement for a single-lead system, not leadless device placement.No office rate

33274 billing questions

How is this different from a conventional pacemaker insertion?

This code is for a self-contained leadless device delivered into the right ventricle by catheter. Codes such as 33207 or 33208 describe a conventional system using transvenous electrode leads.

Can the removal of an existing leadless pacemaker be reported separately?

Yes, when removal is performed during replacement, report the removal service separately with 33275. Document the extraction as well as the new device placement.

Is imaging guidance separately reported?

Imaging guidance and the associated device evaluation are included in this service. Do not separately report those included elements as though they were independent services.

Does this code have a postoperative global period?

Yes. It has a 90-day global period that includes the day-before preoperative visit and related postoperative care.

Which surgical modifiers or assistant services should be considered?

Modifier 50 is inappropriate for this code. CMS permits co-surgeons, restricts payment for an assistant at surgery, and does not permit team surgery.

How are other procedures in the same session paid?

Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to a reduction when performed in the same session.

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 33274PPRRVU2026_Oct_nonQPP.csv, line 3,897 (RVU26D)

Open CMS sourceHow we calculate rates

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