No office rate
33235 is for transvenous pacemaker-electrode removal in a dual-lead system. Use 33237 for the thoracotomy-based epicardial electrode-removal service.
On this page
CMS RVU26D · Effective 2026-10-01
33237 Pacing lead removal Medicare reimbursement rates in Guam
Reports surgical removal of a permanent epicardial pacemaker electrode through a thoracotomy when lead extraction requires direct access to the heart. Compare 33237 office and facility rates across CMS payment localities in Guam.
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.
What does Medicare pay for 33237 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$822.36
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Cardiac device surgery
About 33237: Epicardial pacing lead removal by thoracotomy
Reports surgical removal of a permanent epicardial pacemaker electrode through a thoracotomy when lead extraction requires direct access to the heart.
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.
CMS billing rules for 33237
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU13.49 · 54%
- Practice expense (office) RVU8.15 · 33%
- Malpractice RVU3.22 · 13%
30
Medicare services in 2024 · #5668 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.
33237 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
33234 covers transvenous pacemaker-electrode removal for a single-lead system or one lead; 33237 describes removal through a thoracotomy.
No office rate
33233 removes a pacemaker pulse generator. It does not describe thoracotomy-based removal of an epicardial pacing electrode.
No office rate
33243 concerns thoracotomy-based removal of an implantable defibrillator electrode; 33237 is for an epicardial pacemaker electrode.
Compare 33237 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$822.36
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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 33237 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,866
- Code
- 33237
- Physician work
- 13.49
- Practice expense
- 8.15
- Malpractice
- 3.22
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.49 | × 1.000 | 13.4900 |
| Practice expense | 8.15 | × 1.137 | 9.2666 |
| Malpractice | 3.22 | × 0.579 | 1.8644 |
| Total RVUs | 24.6209 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$822.36
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.49 | 1 |
| Practice expense | 8.15 | 1.137 |
| Malpractice | 3.22 | 0.579 |
(13.49 × 1 + 8.15 × 1.137 + 3.22 × 0.579) × $33.4009 = $822.36
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.
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 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.
3,86333234,,Removal of pacemaker system,A,,7.47,3.62,NA,3.62,,1.76,12.85,12.85,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,86433235,,Removal pacemaker electrode,A,,9.65,5.07,NA,5.07,,2.28,17.00,17.00,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,86533236,,Remove electrode/thoracotomy,A,,12.41,7.92,NA,7.92,,2.97,23.30,23.30,0,090,0.09,0.84,0.07,2,0,0,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,86633237,,Remove electrode/thoracotomy,A,,13.49,8.15,NA,8.15,,3.22,24.86,24.86,0,090,0.09,0.84,0.07,2,0,0,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,86733238,,Remove electrode/thoracotomy,A,,15.02,9.44,NA,9.44,,3.60,28.06,28.06,0,090,0.09,0.84,0.07,2,0,0,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,8683323F,,Clin node stgng docdb/4 surg,I,,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
3,86933240,,Insrt pulse gen w/singl lead,A,,5.66,2.59,NA,2.59,,1.34,9.59,9.59,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014