Billing code 33287: Generator exchangeMedicare rate & RVUs in Guam
Report this code when a surgeon removes and replaces the pulse generator of an implanted phrenic nerve stimulation system, typically for battery depletion or generator failure.
CMS doesn’t publish an office rate for 33287 in Guam.
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 33287 covers
This service removes an implanted phrenic nerve stimulator pulse generator and places a replacement, generally retaining the existing lead or leads. It is commonly performed by a cardiologist or electrophysiologist in a hospital or other surgical setting for a patient receiving phrenic nerve stimulation, such as treatment for central sleep apnea. A generator exchange may be needed when the battery is depleted or the generator has failed.
Report the code for the generator exchange, not for removal alone or for lead replacement. The operative report should document removal of the existing generator and placement of its replacement. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare 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.
33287 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $335.77 |
How the 33287 rate is calculated
Each of 33287’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 · 33287
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.90Practice expense 2.97Malpractice 1.34
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 33287
33287 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33287
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 · 33287
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
33287 without 51 · national facility
$341.02
Generator exchange
33287-51 · Second procedure: 50%
$170.51
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%).
33287 compared with similar codes
Compare codes
33287 vs 33280 vs 33288 vs 33276: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 33280Stimulator removal
- 33280 is for generator removal alone. Choose 33287 when the removed generator is replaced during the service.
- 33288Lead exchange
- 33288 describes removal and replacement of a lead, rather than the pulse generator. Distinguish the component exchanged in the operative report.
- 33276Phrenic stimulator implant
- 33276 is for insertion of a phrenic nerve stimulation system. 33287 is for exchanging the pulse generator in an existing system.
33287 billing questions
When should 33287 be chosen instead of 33280?
Use 33287 when the pulse generator is removed and a replacement generator is placed. Code 33280 describes removal of the generator without replacement.
Does 33287 include replacement of the phrenic nerve lead?
No. This code describes the pulse generator exchange. Lead removal and replacement is represented by 33288 when that service is performed.
Should modifier 50 be appended for a bilateral procedure?
No. Modifier 50 is inappropriate for this code based on its descriptor and anatomy.
What documentation supports reporting 33287?
Document removal of the existing phrenic nerve stimulator pulse generator and placement of the replacement generator. Include the reason for exchange, such as battery depletion or generator failure, when documented.
How does the 90-day global period affect follow-up billing?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the surgical global period.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard 50% 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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