No office rate
Choose 33208 for implantation of a new dual-chamber pacemaker system. Choose 33214 when the procedure upgrades an already implanted system.
On this page
CMS RVU26D · Effective 2026-10-01
33214 Pacemaker upgrade Medicare reimbursement rates in Missouri
Report this service when an existing pacemaker system is surgically upgraded, such as converting a single-chamber system to dual-chamber pacing. Compare 33214 office and facility rates across CMS payment localities in Missouri.
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 33214 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$407.31–$419.82
3 of 3 localities have a supported rate.
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.
Where 33214 pays more and less in Missouri
Cardiology procedure
About 33214: Pacemaker system chamber upgrade
Report this service when an existing pacemaker system is surgically upgraded, such as converting a single-chamber system to dual-chamber pacing.
A pacemaker upgrade changes an existing implanted pacing system to support a different configuration. A common situation is converting a single-chamber system to dual-chamber pacing by adding an atrial lead and adapting or replacing the pulse generator as needed. Cardiologists and electrophysiologists typically perform the procedure in a hospital or outpatient surgical facility, with imaging and device testing used to guide and assess the work.
Select this code when the operative service upgrades the existing system, not when the physician only replaces a pulse generator or inserts a new system. Document the preexisting and resulting configurations, the leads placed or retained, generator work, and the reason for the upgrade. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant payment requires documented medical necessity; co-surgeons are permitted, but team surgery is not permitted.
CMS billing rules for 33214
- 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 RVU7.40 · 58%
- Practice expense (office) RVU3.63 · 28%
- Malpractice RVU1.71 · 13%
204
Medicare services in 2024 · #4313 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.
33214 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
33216 describes inserting one lead into an existing system. This code is for an upgrade of the system configuration, rather than lead insertion alone.
No office rate
33228 describes generator removal and replacement in a dual-lead system. Use this code when the operative work upgrades the existing pacemaker configuration instead.
Compare 33214 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$416.82
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$419.82
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$407.31
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33214 billing questions
When should I report an upgrade rather than a new dual-chamber implant?
Use this code when the physician surgically changes an existing pacemaker system to a new configuration. A new dual-chamber implant, rather than an upgrade of an existing system, is represented by a different service.
Is this code appropriate for a generator-only replacement?
No. A generator exchange that leaves the pacing configuration unchanged is a generator-replacement service; this code describes changing the existing system configuration.
What documentation supports reporting the upgrade?
Record the existing and intended pacing configurations, the lead and generator work performed, and the clinical reason for changing the system. The operative report should make clear that the work upgraded the existing system.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this pacemaker system procedure.
How does the global period affect postoperative visits?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons are permitted; team surgery is 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.
3,84033211,,Insert card electrodes dual,A,,3.06,0.63,NA,0.63,,0.67,4.36,4.36,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,84133212,,Insert pulse gen sngl lead,A,,4.88,2.71,NA,2.71,,1.16,8.75,8.75,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,84233213,,Insert pulse gen dual leads,A,,5.15,2.72,NA,2.72,,1.22,9.09,9.09,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,84333214,,Upgrade of pacemaker system,A,,7.40,3.63,NA,3.63,,1.71,12.74,12.74,0,090,0.09,0.84,0.07,2,0,0,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,84433215,,Reposition pacing-defib lead,A,,4.80,2.30,NA,2.30,,1.14,8.24,8.24,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,84533216,,Insert 1 electrode pm-defib,A,,5.48,3.15,NA,3.15,,1.29,9.92,9.92,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,84633217,,Insert 2 electrode pm-defib,A,,5.45,3.15,NA,3.15,,1.29,9.89,9.89,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00