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Billing code 33227: Pacemaker generator exchangeMedicare rate & RVUs

Report this service when a physician removes and replaces a permanent pacemaker generator while retaining the existing single-lead pacing system.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.1K Medicare services in 2024

Medicare pays $301.94 for 33227 nationally in a facility.

Medicare rate · 33227

Pacemaker generator exchange

Swap in your local Medicare rate.

Work RVUs
5.12
Total RVUs
9.04
Global days
090

National rate · 2026

$301.94

Facility setting, before claim adjustments.

See every locality for 33227 → · 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 33227 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 33227 covers

An electrophysiologist or other qualified physician opens the pacemaker pocket, disconnects the depleted or malfunctioning pulse generator from the existing pacing lead, attaches a replacement generator, and closes the pocket. This exchange is commonly performed in a hospital or outpatient facility when the generator reaches its replacement point or fails; the existing single-lead system remains in place.

Select the code based on the pacemaker system’s lead count, not simply the generator’s age or the reason for exchange. Documentation should identify the existing single-lead system, the generator removed and implanted, and the reason for replacement. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this single-generator service. CMS does not pay an assistant at surgery; 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 33227 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

33227 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$273.09
Alaska*Unavailable$375.19
ArizonaUnavailable$293.32
ArkansasUnavailable$269.58
AtlantaUnavailable$312.03
AustinUnavailable$302.93
BakersfieldUnavailable$298.08
Baltimore/Surr. CntysUnavailable$320.87
BeaumontUnavailable$290.93
BrazoriaUnavailable$293.61

33227 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
33227 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 33227 rate is calculated

Each of 33227’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 · 33227

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.12Practice expense 2.71Malpractice 1.21

9.0400 adjusted RVUs×$33.4009 conversion factor=$301.94

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

Payment rules and modifiers for 33227

33227 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33227

Pacemaker generator exchange

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 · 33227

Pacemaker generator exchange

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

33227 without 51 · national facility

$301.94

Pacemaker generator exchange

33227-51 · Second procedure: 50%

$150.97

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

33227 compared with similar codes

Compare codes

33227 vs 33228 vs 33229 vs 33233 vs 33214: national Medicare rates

Swap in your local Medicare rate.

  • 33227
    Pacemaker generator exchange · 5.12 wRVU
    —
  • 33228
    Pacemaker generator exchange · 5.38 wRVU
    —
  • 33229
    Pacemaker replacement · 5.65 wRVU
    —
  • 33233
    Pacemaker generator removal · 3.06 wRVU
    —
  • 33214
    Pacemaker upgrade · 7.4 wRVU
    —

How to choose

33228Pacemaker generator exchange
33228 applies when the exchanged generator is part of a dual-lead pacemaker system; 33227 is for a single-lead system.
33229Pacemaker replacement
33229 is the generator-exchange code for a multiple-lead pacemaker system, rather than the single-lead system reported with 33227.
33233Pacemaker generator removal
33233 describes pacemaker generator removal without replacement. When a new generator is implanted during the same exchange, use the applicable replacement code instead.
33214Pacemaker upgrade
33214 describes an upgrade of the pacemaker system. Use 33227 when the service is a generator exchange that retains the existing single-lead configuration.

Codes related to 33227

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

Codes related to 33227
CodeHow it relatesNational office range
Same family
33228Pacemaker generator exchangeGenerator exchange for a dual-lead pacemaker system.No office rate
33229Pacemaker replacementGenerator exchange for a multiple-lead pacemaker system.No office rate
Used instead
33233Pacemaker generator removalRemoval-only service when the pacemaker generator is not replaced.No office rate
33214Pacemaker upgradeUsed for a pacemaker system upgrade rather than an exchange retaining the single-lead configuration.No office rate

33227 billing questions

How is this code distinguished from 33228?

Use 33227 for replacement of a generator in a single-lead pacemaker system. Code 33228 is for a dual-lead system.

Is removal of the old generator included?

Yes. The service includes removing the existing generator as part of the exchange; do not separately report generator removal for that same exchange.

What documentation supports the single-lead selection?

Document the pacemaker configuration and the lead count, along with the generator removed, replacement generator, and reason for the exchange.

Should modifier 50 be reported?

No. Modifier 50 is inappropriate for this single-generator exchange.

Can an assistant or co-surgeon be reported?

CMS does not pay an assistant at surgery for this code. Co-surgeon and team-surgery reporting 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 33227PPRRVU2026_Oct_nonQPP.csv, line 3,856 (RVU26D)

Open CMS sourceHow we calculate rates

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