Billing code 33227: Pacemaker generator exchangeMedicare rate & RVUs in Alaska
Report this service when a physician removes and replaces a permanent pacemaker generator while retaining the existing single-lead pacing system.
CMS doesn’t publish an office rate for 33227 in Alaska.
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 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.
33227 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $375.19 |
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
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
| 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not 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 · 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.
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%).
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.
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.
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
Fee sheets
Put 33227 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →