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Billing code 33221: Pacemaker generatorMedicare rate & RVUs

Insertion of a pulse generator connected to an existing multiple-lead pacemaker system, typically when the leads remain in place and only the generator is implanted.

CMS RVU26DEffective Oct 1, 2026109 payment localities167 Medicare services in 2024

Medicare pays $318.64 for 33221 nationally in a facility.

Medicare rate · 33221

Pacemaker generator

Swap in your local Medicare rate.

Work RVUs
5.41
Total RVUs
9.54
Global days
090

National rate · 2026

$318.64

Facility setting, before claim adjustments.

See every locality for 33221 → · 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 33221 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 33221 covers

Code 33221 describes placing a pacemaker pulse generator and connecting it to an existing multiple-lead pacing system. Electrophysiologists and other qualified cardiac surgeons commonly perform the procedure in a hospital operating room or electrophysiology setting. A typical clinical context is a multilead system, such as cardiac resynchronization pacing, whose leads are already in place and will be connected to the new generator.

Report 33221 when the procedure is limited to generator insertion with existing multiple leads; documentation should identify the existing leads and describe generator placement and connection. When the generator is removed and replaced, consider the replacement code for a multiple-lead system instead. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is statutorily restricted, 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 33221 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

33221 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$288.09
Alaska*Unavailable$395.81
ArizonaUnavailable$309.50
ArkansasUnavailable$284.37
AtlantaUnavailable$329.36
AustinUnavailable$319.60
BakersfieldUnavailable$314.34
Baltimore/Surr. CntysUnavailable$338.67
BeaumontUnavailable$307.05
BrazoriaUnavailable$309.76

33221 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
33221 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 33221 rate is calculated

Each of 33221’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 · 33221

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.41Practice expense 2.84Malpractice 1.29

9.5400 adjusted RVUs×$33.4009 conversion factor=$318.64

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 33221

33221 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33221

Pacemaker generator

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 · 33221

Pacemaker generator

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

33221 without 51 · national facility

$318.64

Pacemaker generator

33221-51 · Second procedure: 50%

$159.32

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

33221 compared with similar codes

Compare codes

33221 vs 33213 vs 33229 vs 33208: national Medicare rates

Swap in your local Medicare rate.

  • 33221
    Pacemaker generator · 5.41 wRVU
    —
  • 33213
    Pacemaker generator · 5.15 wRVU
    —
  • 33229
    Pacemaker replacement · 5.65 wRVU
    —
  • 33208
    Pacemaker implant · 8.31 wRVU
    —

How to choose

33213Pacemaker generator
Choose 33213 for generator insertion with an existing dual-lead system. Use 33221 when the existing pacing system has multiple leads.
33229Pacemaker replacement
33229 describes removing and replacing a generator in a multiple-lead system. Code 33221 is for generator insertion without that removal-and-replacement service.
33208Pacemaker implant
33208 describes implantation of a new atrial-and-ventricular pacing system. Code 33221 applies when multiple leads are already present and the service is generator insertion.

Codes related to 33221

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

Codes related to 33221
CodeHow it relatesNational office range
Same family
33212Pacemaker generatorGenerator-only insertion with an existing single-lead pacing system.No office rate
33213Pacemaker generatorGenerator-only insertion with an existing dual-lead pacing system.No office rate
Used instead
33229Pacemaker replacementUse for removal and replacement of a generator in a multiple-lead pacing system.No office rate
33208Pacemaker implantDescribes implantation of a new atrial-and-ventricular pacemaker system rather than generator-only insertion.No office rate

33221 billing questions

How is 33221 different from 33213?

33221 is for a generator connected to an existing multiple-lead system. Code 33213 is the generator-only choice for an existing dual-lead system.

Should 33221 be used when the generator is replaced?

Use the multiple-lead generator removal-and-replacement code, 33229, when the existing generator is removed and replaced. Code 33221 describes generator insertion rather than removal and replacement.

Does 33221 include placement of new leads?

It describes generator insertion with multiple leads already in place, not placement of new leads. The operative report should establish whether the leads were existing or newly implanted.

Can modifier 50 be reported?

No. CMS identifies bilateral adjustment as inappropriate for this code.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

How are other same-session procedures paid?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Assistant-at-surgery payment is statutorily restricted; 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
RVUs for 33221PPRRVU2026_Oct_nonQPP.csv, line 3,850 (RVU26D)

Open CMS sourceHow we calculate rates

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