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Billing code 33214: Pacemaker upgradeMedicare rate & RVUs

Report this service when an existing pacemaker system is surgically upgraded, such as converting a single-chamber system to dual-chamber pacing.

CMS RVU26DEffective Oct 1, 2026109 payment localities204 Medicare services in 2024

Medicare pays $425.53 for 33214 nationally in a facility.

Medicare rate · 33214

Pacemaker upgrade

Work RVUs
7.4
Total RVUs
12.74
Global days
090

National rate · 2026

$425.53

Facility setting, before claim adjustments.

See every locality for 33214 →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.

On this page 10 sections
  1. Medicare rate
  2. What 33214 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 33214 covers

A pacemaker upgrade changes an existing implanted pacing system to support a different configuration. A common situation is converting a single-chamber system to dual-chamber pacing by adding an atrial lead and adapting or replacing the pulse generator as needed. Cardiologists and electrophysiologists typically perform the procedure in a hospital or outpatient surgical facility, with imaging and device testing used to guide and assess the work.

Select this code when the operative service upgrades the existing system, not when the physician only replaces a pulse generator or inserts a new system. Document the preexisting and resulting configurations, the leads placed or retained, generator work, and the reason for the upgrade. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant payment requires documented medical necessity; co-surgeons are permitted, but 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 33214 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

33214 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$385.58
Alaska*Unavailable$531.35
ArizonaUnavailable$413.54
ArkansasUnavailable$380.73
AtlantaUnavailable$439.69
AustinUnavailable$426.54
BakersfieldUnavailable$419.53
Baltimore/Surr. CntysUnavailable$451.87
BeaumontUnavailable$410.56
BrazoriaUnavailable$413.85

33214 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
33214 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 33214 rate is calculated

Each of 33214’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 · 33214

RVUs × geographic indexes × conversion factor

Work7.40

7.40 RVUs× 1.000 GPCI

Practice expense3.63

3.63 RVUs× 1.000 GPCI

Malpractice1.71

1.71 RVUs× 1.000 GPCI

Adjusted RVUs

12.7400

Conversion factor

$33.4009

Medicare rate

$425.53

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

Payment rules and modifiers for 33214

33214 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33214

Pacemaker upgrade

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)0Not paid without supporting documentation.
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 · 33214

Pacemaker upgrade

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

33214 without 51 · national facility

$425.53

Pacemaker upgrade

33214-51 · Second procedure: 50%

$212.77

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

33214 compared with similar codes

Compare codes · National

4 codes, side by side

  • 33214

    Pacemaker upgrade7.4 wRVU

    Not priced

  • 33208

    Pacemaker implant8.31 wRVU

    Not priced

  • 33216

    ICD lead insertion5.48 wRVU

    Not priced

  • 33228

    Pacemaker generator exchange5.38 wRVU

    Not priced

How to choose

33208Pacemaker implant
Choose 33208 for implantation of a new dual-chamber pacemaker system. Choose 33214 when the procedure upgrades an already implanted system.
33216ICD lead insertion
33216 describes inserting one lead into an existing system. This code is for an upgrade of the system configuration, rather than lead insertion alone.
33228Pacemaker generator exchange
33228 describes generator removal and replacement in a dual-lead system. Use this code when the operative work upgrades the existing pacemaker configuration instead.

Codes related to 33214

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

Codes related to 33214
CodeHow it relatesNational office range
Used instead
33208Pacemaker implantRepresents implantation of a new dual-chamber pacemaker system rather than upgrading an existing system.No office rate
33216ICD lead insertionCovers insertion of one lead into an existing system when the service is lead insertion, not a system upgrade.No office rate
33228Pacemaker generator exchangeFor generator removal and replacement in an existing dual-lead system without changing its configuration.No office rate
33229Pacemaker replacementFor generator removal and replacement in an existing multiple-lead system without an upgrade.No office rate

33214 billing questions

When should I report an upgrade rather than a new dual-chamber implant?

Use this code when the physician surgically changes an existing pacemaker system to a new configuration. A new dual-chamber implant, rather than an upgrade of an existing system, is represented by a different service.

Is this code appropriate for a generator-only replacement?

No. A generator exchange that leaves the pacing configuration unchanged is a generator-replacement service; this code describes changing the existing system configuration.

What documentation supports reporting the upgrade?

Record the existing and intended pacing configurations, the lead and generator work performed, and the clinical reason for changing the system. The operative report should make clear that the work upgraded the existing system.

Should modifier 50 be appended?

No. Modifier 50 is inappropriate for this pacemaker system procedure.

How does the global period affect postoperative visits?

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

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons are permitted; team surgery is 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 33214PPRRVU2026_Oct_nonQPP.csv, line 3,843 (RVU26D)

Open CMS sourceHow we calculate rates

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