Billing code 33237: Pacing lead removalMedicare rate & RVUs in Alabama
Reports surgical removal of a permanent epicardial pacemaker electrode through a thoracotomy when lead extraction requires direct access to the heart.
CMS doesn’t publish an office rate for 33237 in Alabama.
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 9 sections
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.
33237 in Alabama
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Unavailable | $749.64 |
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
Work13.49
13.49 RVUs× 1.000 GPCI
Practice expense8.15
8.15 RVUs× 1.000 GPCI
Malpractice3.22
3.22 RVUs× 1.000 GPCI
Adjusted RVUs
24.8600
Conversion factor
$33.4009
Medicare rate
$830.35
Every GPCI starts 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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 2 | Permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share 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.
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%).
33237 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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