No office rate
Choose 33279 when the transvenous lead or leads are removed without removal of the full system. This code is for complete system explant.
On this page
CMS RVU26D · Effective 2026-10-01
33278 Stimulator removal Medicare reimbursement rates in Missouri
Removal of an implanted phrenic nerve stimulation system, including its pulse generator and transvenous lead or leads, when the full system is explanted. Compare 33278 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 33278 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
$479.04–$491.52
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 33278 pays more and less in Missouri
Cardiac device surgery
About 33278: Complete phrenic nerve stimulator removal
Removal of an implanted phrenic nerve stimulation system, including its pulse generator and transvenous lead or leads, when the full system is explanted.
This service covers removal of an implanted phrenic nerve stimulation system, including the pulse generator and transvenous lead or leads. The system may be used to treat central sleep apnea. A cardiologist, electrophysiologist, or other qualified physician typically performs the explant in a hospital operating room or electrophysiology setting, for example when the entire device is being removed rather than exchanged or revised.
Report this code when documentation supports removal of the complete system. If only the transvenous lead or only the pulse generator is removed, use the code that describes that component-specific service. Document the indication and which system components were explanted. 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% reduction. Medicare does not pay an assistant at surgery for this service; co-surgeon and team-surgery reporting are not permitted. Modifier 50 is not appropriate.
CMS billing rules for 33278
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU9.31 · 63%
- Practice expense (office) RVU3.51 · 24%
- Malpractice RVU2.06 · 14%
20
Medicare services in 2024 · #5915 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.
33278 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
33280 describes removal of the pulse generator alone; this code describes removal of the generator and transvenous lead or leads.
No office rate
33287 is for removing and replacing the pulse generator while retaining the leads. Use this code when the complete system is removed.
No office rate
33288 is for removing and replacing transvenous lead components while retaining the generator, rather than explanting the complete system.
Compare 33278 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
$488.27
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$491.52
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$479.04
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33278 billing questions
When should this code be used instead of a component-removal code?
Use this code when the complete phrenic nerve stimulator system is removed, including the pulse generator and transvenous lead or leads. Removal of only the lead or only the generator is reported with the corresponding component-specific code.
How does this differ from removing and replacing the pulse generator?
This code describes complete system removal. When the generator is replaced and the leads are retained, consider the generator removal-and-replacement code instead.
What documentation supports reporting complete system removal?
Document the reason for explant and identify the pulse generator and transvenous lead or leads removed. The record should distinguish a complete explant from removal of a single component.
What is included in the Medicare global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 or an assistant-at-surgery claim be reported?
Modifier 50 is not appropriate for this service. Medicare does not pay an assistant at surgery for this code.
Can co-surgeons or a surgical team report this procedure?
Co-surgeon and team-surgery reporting are not permitted for this service.
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.
3,89833275,,Tcat rmvl perm ldls pm w/img,A,,8.38,3.01,NA,3.01,,2.00,13.39,13.39,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,89933276,,Insj phrnc nrv stim sys,A,,9.26,3.76,NA,3.76,,2.11,15.13,15.13,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,90033277,,Insj phrnc nrv stim transvns,A,,5.29,1.09,NA,1.09,,1.27,7.65,7.65,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,90133278,,Rmvl phrnc nrv stim sys,A,,9.31,3.51,NA,3.51,,2.06,14.88,14.88,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,90233279,,Rmvl phrnc nrv stim transvns,A,,5.28,2.67,NA,2.67,,1.29,9.24,9.24,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,90333280,,Rmvl phrnc nrv stim pg only,A,,2.96,2.09,NA,2.09,,0.70,5.75,5.75,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,90433281,,Reposg phrnc nrv stim trnsvn,A,,5.85,2.89,NA,2.89,,1.40,10.14,10.14,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00