No office rate
Use 33227 for exchange in a single-lead pacemaker system; 33228 is for an existing dual-lead system.
On this page
CMS RVU26D · Effective 2026-10-01
33228 in Delaware
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$310.77
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Cardiac device surgery
About 33228: Dual-lead pacemaker generator exchange
Report this service when a physician removes and replaces the pulse generator of an existing permanent pacemaker with a dual-lead configuration.
The physician removes a depleted or malfunctioning pulse generator from an existing permanent pacemaker system and connects a replacement while retaining the dual-lead configuration. A cardiologist or electrophysiologist typically performs the procedure in a cardiac catheterization or electrophysiology lab when the generator reaches battery end of service or needs replacement for another documented reason.
Select this code based on the existing system’s dual-lead configuration and an actual generator exchange, not on the number of leads newly implanted. The operative report should identify the existing system, generator removal and replacement, and lead configuration; generator removal is included in the exchange. CMS assigns a 90-day major-surgery global period, including 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%. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 33228
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.38 · 57%
- Practice expense (office) RVU2.78 · 29%
- Malpractice RVU1.28 · 14%
31.6K
Medicare services in 2024 · #953 by national volume
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.
33228 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
Use 33229 for exchange in a multiple-lead pacemaker system. The dual-lead configuration points to 33228.
No office rate
33230 describes insertion of a pulse generator with dual leads, rather than replacement of a generator in an existing dual-lead system.
No office rate
33233 is for generator removal without the replacement included in 33228.
The same code, a different location
How does Delaware compare?
33228 across payment areas
Same release and payment basis · bars start at $0
Delaware · This locality
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Alabama
Alabama · 33228
Office
Unavailable
Facility
$285.14
No comparable office rate is available.
Arkansas
Arkansas · 33228
Office
Unavailable
Facility
$281.48
No comparable office rate is available.
Arizona
Arizona · 33228
Office
Unavailable
Facility
$306.27
No comparable office rate is available.
Bakersfield
California · 33228
Office
Unavailable
Facility
$310.92
No comparable office rate is available.
Chico
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
El Centro
California · 33228
Office
Unavailable
Facility
$307.65
No comparable office rate is available.
Fresno
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
Hanford-Corcoran
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
Madera
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
Merced
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
Modesto
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
Napa
California · 33228
Office
Unavailable
Facility
$335.12
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 33228
Office
Unavailable
Facility
$321.12
No comparable office rate is available.
Redding
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
Rest Of California
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 33228
Office
Unavailable
Facility
$321.17
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 33228
Office
Unavailable
Facility
$317.07
No comparable office rate is available.
Salinas
California · 33228
Office
Unavailable
Facility
$315.80
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 33228
Office
Unavailable
Facility
$319.31
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 33228
Office
Unavailable
Facility
$347.32
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 33228
Office
Unavailable
Facility
$345.86
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 33228
Office
Unavailable
Facility
$356.28
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 33228
Office
Unavailable
Facility
$350.33
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 33228
Office
Unavailable
Facility
$311.43
No comparable office rate is available.
Santa Cruz-Watsonville
California · 33228
Office
Unavailable
Facility
$319.20
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 33228
Office
Unavailable
Facility
$315.91
No comparable office rate is available.
Santa Rosa-Petaluma
California · 33228
Office
Unavailable
Facility
$322.03
No comparable office rate is available.
Stockton
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
Vallejo
California · 33228
Office
Unavailable
Facility
$333.02
No comparable office rate is available.
Visalia
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
Yuba City
California · 33228
Office
Unavailable
Facility
$307.44
No comparable office rate is available.
Colorado
Colorado · 33228
Office
Unavailable
Facility
$314.04
No comparable office rate is available.
Connecticut
Connecticut · 33228
Office
Unavailable
Facility
$335.03
No comparable office rate is available.
Fort Lauderdale
Florida · 33228
Office
Unavailable
Facility
$351.06
No comparable office rate is available.
Rest Of Florida
Florida · 33228
Office
Unavailable
Facility
$332.72
No comparable office rate is available.
Atlanta
Georgia · 33228
Office
Unavailable
Facility
$325.92
No comparable office rate is available.
Rest Of Georgia
Georgia · 33228
Office
Unavailable
Facility
$313.48
No comparable office rate is available.
Hawaii, Guam
Hawaii · 33228
Office
Unavailable
Facility
$310.03
No comparable office rate is available.
Iowa
Iowa · 33228
Office
Unavailable
Facility
$281.63
No comparable office rate is available.
Idaho
Idaho · 33228
Office
Unavailable
Facility
$285.35
No comparable office rate is available.
East St. Louis
Illinois · 33228
Office
Unavailable
Facility
$351.23
No comparable office rate is available.
Rest Of Illinois
Illinois · 33228
Office
Unavailable
Facility
$331.30
No comparable office rate is available.
Suburban Chicago
Illinois · 33228
Office
Unavailable
Facility
$352.07
No comparable office rate is available.
Indiana
Indiana · 33228
Office
Unavailable
Facility
$286.55
No comparable office rate is available.
Kansas
Kansas · 33228
Office
Unavailable
Facility
$285.18
No comparable office rate is available.
Kentucky
Kentucky · 33228
Office
Unavailable
Facility
$301.36
No comparable office rate is available.
New Orleans
Louisiana · 33228
Office
Unavailable
Facility
$315.64
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 33228
Office
Unavailable
Facility
$302.83
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 33228
Office
Unavailable
Facility
$335.98
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 33228
Office
Unavailable
Facility
$314.42
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 33228
Office
Unavailable
Facility
$335.09
No comparable office rate is available.
Rest Of Maryland
Maryland · 33228
Office
Unavailable
Facility
$314.71
No comparable office rate is available.
Rest Of Maine
Maine · 33228
Office
Unavailable
Facility
$291.72
No comparable office rate is available.
Southern Maine
Maine · 33228
Office
Unavailable
Facility
$298.69
No comparable office rate is available.
Detroit
Michigan · 33228
Office
Unavailable
Facility
$341.38
No comparable office rate is available.
Rest Of Michigan
Michigan · 33228
Office
Unavailable
Facility
$312.74
No comparable office rate is available.
Minnesota
Minnesota · 33228
Office
Unavailable
Facility
$287.90
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 33228
Office
Unavailable
Facility
$308.66
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 33228
Office
Unavailable
Facility
$310.93
No comparable office rate is available.
Rest Of Missouri
Missouri · 33228
Office
Unavailable
Facility
$301.38
No comparable office rate is available.
Mississippi
Mississippi · 33228
Office
Unavailable
Facility
$291.24
No comparable office rate is available.
Montana**
Montana · 33228
Office
Unavailable
Facility
$315.22
No comparable office rate is available.
North Carolina
North Carolina · 33228
Office
Unavailable
Facility
$293.65
No comparable office rate is available.
North Dakota**
North Dakota · 33228
Office
Unavailable
Facility
$289.91
No comparable office rate is available.
Nebraska
Nebraska · 33228
Office
Unavailable
Facility
$281.56
No comparable office rate is available.
New Hampshire
New Hampshire · 33228
Office
Unavailable
Facility
$313.77
No comparable office rate is available.
Northern Nj
New Jersey · 33228
Office
Unavailable
Facility
$344.39
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 33228
Office
Unavailable
Facility
$335.18
No comparable office rate is available.
New Mexico
New Mexico · 33228
Office
Unavailable
Facility
$316.19
No comparable office rate is available.
Nevada**
Nevada · 33228
Office
Unavailable
Facility
$308.26
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 33228
Office
Unavailable
Facility
$380.99
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 33228
Office
Unavailable
Facility
$341.19
No comparable office rate is available.
Queens
New York · 33228
Office
Unavailable
Facility
$362.60
No comparable office rate is available.
Rest Of New York
New York · 33228
Office
Unavailable
Facility
$297.96
No comparable office rate is available.
Ohio
Ohio · 33228
Office
Unavailable
Facility
$307.57
No comparable office rate is available.
Oklahoma
Oklahoma · 33228
Office
Unavailable
Facility
$295.84
No comparable office rate is available.
Portland
Oregon · 33228
Office
Unavailable
Facility
$317.54
No comparable office rate is available.
Rest Of Oregon
Oregon · 33228
Office
Unavailable
Facility
$302.24
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 33228
Office
Unavailable
Facility
$330.60
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 33228
Office
Unavailable
Facility
$305.34
No comparable office rate is available.
Puerto Rico
Puerto Rico · 33228
Office
Unavailable
Facility
$315.68
No comparable office rate is available.
Rhode Island
Rhode Island · 33228
Office
Unavailable
Facility
$317.17
No comparable office rate is available.
South Carolina
South Carolina · 33228
Office
Unavailable
Facility
$301.83
No comparable office rate is available.
South Dakota**
South Dakota · 33228
Office
Unavailable
Facility
$286.92
No comparable office rate is available.
Tennessee
Tennessee · 33228
Office
Unavailable
Facility
$287.06
No comparable office rate is available.
Austin
Texas · 33228
Office
Unavailable
Facility
$316.18
No comparable office rate is available.
Beaumont
Texas · 33228
Office
Unavailable
Facility
$303.91
No comparable office rate is available.
Brazoria
Texas · 33228
Office
Unavailable
Facility
$306.50
No comparable office rate is available.
Dallas
Texas · 33228
Office
Unavailable
Facility
$310.48
No comparable office rate is available.
Fort Worth
Texas · 33228
Office
Unavailable
Facility
$310.11
No comparable office rate is available.
Galveston
Texas · 33228
Office
Unavailable
Facility
$308.74
No comparable office rate is available.
Houston
Texas · 33228
Office
Unavailable
Facility
$332.17
No comparable office rate is available.
Rest Of Texas
Texas · 33228
Office
Unavailable
Facility
$306.42
No comparable office rate is available.
Utah
Utah · 33228
Office
Unavailable
Facility
$305.37
No comparable office rate is available.
Virginia
Virginia · 33228
Office
Unavailable
Facility
$301.16
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 33228
Office
Unavailable
Facility
$315.68
No comparable office rate is available.
Vermont
Vermont · 33228
Office
Unavailable
Facility
$293.26
No comparable office rate is available.
Rest Of Washington
Washington · 33228
Office
Unavailable
Facility
$312.34
No comparable office rate is available.
Seattle (King Cnty)
Washington · 33228
Office
Unavailable
Facility
$337.54
No comparable office rate is available.
Wisconsin
Wisconsin · 33228
Office
Unavailable
Facility
$281.82
No comparable office rate is available.
West Virginia
West Virginia · 33228
Office
Unavailable
Facility
$321.57
No comparable office rate is available.
Wyoming**
Wyoming · 33228
Office
Unavailable
Facility
$304.19
No comparable office rate is available.
See how rates vary across the country
33228 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 33228 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$341.85
$310.77 × 110% = $341.85
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 33228 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
3,857
- Code
- 33228
- Physician work
- 5.38
- Practice expense
- 2.78
- Malpractice
- 1.28
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.38 | × 1.005 | 5.4069 |
| Practice expense | 2.78 | × 0.988 | 2.7466 |
| Malpractice | 1.28 | × 0.899 | 1.1507 |
| Total RVUs | 9.3043 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$310.77
Open 33228 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.38 | 1.005 |
| Practice expense | 2.78 | 0.988 |
| Malpractice | 1.28 | 0.899 |
(5.38 × 1.005 + 2.78 × 0.988 + 1.28 × 0.899) × $33.4009 = $310.77
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
33228 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $310.77 | RVU26D |
| 2026-07-01 | Not available in this setting | $310.77 | RVU26C |
| 2026-04-01 | Not available in this setting | $310.77 | RVU26B |
| 2026-01-01 | Not available in this setting | $310.77 | RVU26A |
| 2025-10-01 | Not available in this setting | $338.85 | RVU25D |
| 2025-07-01 | Not available in this setting | $338.85 | RVU25C |
| 2025-04-01 | Not available in this setting | $338.85 | RVU25B |
| 2025-01-01 | Not available in this setting | $338.85 | RVU25A |
33228 billing questions
How does 33228 differ from the single- and multiple-lead exchange codes?
33228 is for exchange of a generator in an existing dual-lead system. Use 33227 for a single-lead system and 33229 for a system with multiple leads.
Can the generator removal be reported separately?
No. Removal of the existing generator is part of the exchange reported with 33228.
What documentation supports 33228?
The operative report should establish that the existing pacemaker generator was removed and replaced and identify the system as dual-lead.
Is 33228 used for a new dual-lead pacemaker implant?
No. It describes exchange of a generator in an existing system. Code 33230 describes insertion of a pulse generator with dual leads.
What Medicare surgical payment rules affect this service?
It has a 90-day global period, and same-session multiple procedures are subject to the standard reduction: the highest-valued procedure is paid in full and others at 50%. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,85433225,,L ventric pacing lead add-on,A,,8.12,1.78,NA,1.78,,1.91,11.81,11.81,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85533226,,Reposition l ventric lead,A,,8.46,2.20,NA,2.20,,2.01,12.67,12.67,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85633227,,Remove&replace pm gen singl,A,,5.12,2.71,NA,2.71,,1.21,9.04,9.04,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85733228,,Remv&replc pm gen dual lead,A,,5.38,2.78,NA,2.78,,1.28,9.44,9.44,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85833229,,Remv&replc pm gen mult leads,A,,5.65,2.89,NA,2.89,,1.33,9.87,9.87,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,8593322F,,Melanomaajcc stage 0 or ia,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3,86033230,,Insrt pulse gen w/dual leads,A,,5.92,2.64,NA,2.64,,1.41,9.97,9.97,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503