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Billing code 33237: Pacing lead removalMedicare rate & RVUs

Reports surgical removal of a permanent epicardial pacemaker electrode through a thoracotomy when lead extraction requires direct access to the heart.

CMS RVU26DEffective Oct 1, 2026109 payment localities30 Medicare services in 2024

Medicare pays $830.35 for 33237 nationally in a facility.

Medicare rate · 33237

Pacing lead removal

Swap in your local Medicare rate.

Work RVUs
13.49
Total RVUs
24.86
Global days
090

National rate · 2026

$830.35

Facility setting, before claim adjustments.

See every locality for 33237 → · 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 33237 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 33237 covers

This service involves opening the chest to expose and remove a permanent epicardial pacing electrode attached to the heart’s outer surface. It is performed by a cardiac surgeon when the electrode cannot be removed through a transvenous extraction approach or when the lead’s location or clinical circumstances call for direct surgical access. The procedure is generally performed in a hospital operating room, often as part of a broader cardiac-device operation.

Report 33237 for the thoracotomy-based electrode-removal service, rather than a code for transvenous pacemaker-lead removal or generator removal alone. The operative report should identify the epicardial electrode removed and document the thoracotomy approach. CMS assigns 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 multiple-procedure reduction. Assistant-at-surgery payment requires documentation of 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 33237 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

33237 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$749.64
Alaska*Unavailable$1,025.04
ArizonaUnavailable$806.42
ArkansasUnavailable$739.80
AtlantaUnavailable$857.67
AustinUnavailable$834.78
BakersfieldUnavailable$822.99
Baltimore/Surr. CntysUnavailable$882.92
BeaumontUnavailable$798.21
BrazoriaUnavailable$807.84

33237 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
33237 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 33237 rate is calculated

Each of 33237’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 · 33237

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.49Practice expense 8.15Malpractice 3.22

24.8600 adjusted RVUs×$33.4009 conversion factor=$830.35

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

Payment rules and modifiers for 33237

33237 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33237

Pacing lead removal

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 · 33237

Pacing lead removal

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

33237 without 51 · national facility

$830.35

Pacing lead removal

33237-51 · Second procedure: 50%

$415.18

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

33237 compared with similar codes

Compare codes

33237 vs 33235 vs 33234 vs 33233 vs 33243: national Medicare rates

Swap in your local Medicare rate.

  • 33237
    Pacing lead removal · 13.49 wRVU
    —
  • 33235
    Pacemaker lead removal · 9.65 wRVU
    —
  • 33234
    Pacemaker lead removal · 7.47 wRVU
    —
  • 33233
    Pacemaker generator removal · 3.06 wRVU
    —
  • 33243
    ICD lead removal · 22.98 wRVU
    —

How to choose

33235Pacemaker lead removal
33235 is for transvenous pacemaker-electrode removal in a dual-lead system. Use 33237 for the thoracotomy-based epicardial electrode-removal service.
33234Pacemaker lead removal
33234 covers transvenous pacemaker-electrode removal for a single-lead system or one lead; 33237 describes removal through a thoracotomy.
33233Pacemaker generator removal
33233 removes a pacemaker pulse generator. It does not describe thoracotomy-based removal of an epicardial pacing electrode.
33243ICD lead removal
33243 concerns thoracotomy-based removal of an implantable defibrillator electrode; 33237 is for an epicardial pacemaker electrode.

Codes related to 33237

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

Codes related to 33237
CodeHow it relatesNational office range
Same family
33236Lead removalRelated thoracotomy-based epicardial electrode removal code in the same procedure family.No office rate
33238Pacing lead removalRelated thoracotomy-based epicardial electrode removal code in the same procedure family.No office rate
Used instead
33235Pacemaker lead removalRemoval of transvenous pacemaker electrodes rather than thoracotomy-based epicardial electrodes.No office rate
33234Pacemaker lead removalTransvenous pacemaker-electrode removal for a single-lead system or one lead.No office rate
33233Pacemaker generator removalRemoval of a pacemaker pulse generator, rather than an epicardial electrode.No office rate
33243ICD lead removalThoracotomy-based removal of an implantable defibrillator electrode.No office rate

33237 billing questions

How is 33237 different from transvenous pacemaker-lead removal?

33237 describes removal through a thoracotomy, with direct surgical access to an epicardial electrode. Codes 33234 and 33235 describe transvenous pacemaker-electrode removal.

Is generator removal included when the lead is removed?

The lead-removal service is distinct from removal of a pulse generator. Report generator removal separately only when that service is performed and separately reportable.

What documentation supports 33237?

The operative report should identify the permanent epicardial pacing electrode removed and describe the thoracotomy approach used to reach it.

Can an assistant surgeon be reported?

Assistant-at-surgery payment is available only when the record documents medical necessity. CMS permits co-surgeons for this service.

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

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

What happens when another procedure is performed in the same session?

The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure reduction.

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 33237PPRRVU2026_Oct_nonQPP.csv, line 3,866 (RVU26D)

Open CMS sourceHow we calculate rates

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