Billing code 33236: Lead removalMedicare rate & RVUs in Nevada
Report this service when a surgeon removes permanent pacemaker electrode(s) through a thoracotomy rather than by a transvenous approach.
CMS doesn’t publish an office rate for 33236 in Nevada.
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 33236 covers
This service covers surgical removal of permanent pacemaker electrode(s) through an incision into the chest. It is generally performed by a cardiac or cardiothoracic surgeon when the lead is removed through an open chest approach, such as removal of an epicardial lead. The operative report should establish the thoracotomy approach and identify the pacemaker electrode(s) removed.
Choose this code for electrode removal alone; when the pacemaker pulse generator and electrode(s) are removed through thoracotomy, compare the service with 33237. Transvenous pacemaker lead extraction is represented by different codes. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. In a session with multiple procedures, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity. Co-surgeons are permitted; team surgery is 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.
33236 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | Unavailable | $761.94 |
How the 33236 rate is calculated
Each of 33236’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 · 33236
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.41Practice expense 7.92Malpractice 2.97
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 33236
33236 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33236
Lead removal
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 2 | 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 · 33236
Lead removal
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
33236 without 51 · national facility
$778.24
Lead removal
33236-51 · Second procedure: 50%
$389.12
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%).
33236 compared with similar codes
Compare codes
33236 vs 33234 vs 33235 vs 33237 vs 33243: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 33234Pacemaker lead removal
- 33234 is for transvenous pacemaker electrode removal in a single-lead system. Use 33236 when the electrode(s) are removed through thoracotomy.
- 33235Pacemaker lead removal
- 33235 covers transvenous electrode removal for a dual-lead pacemaker system. The thoracotomy approach distinguishes 33236.
- 33237Pacing lead removal
- 33237 includes removal of the pacemaker pulse generator along with electrode(s) through thoracotomy; 33236 describes electrode removal through thoracotomy.
- 33243ICD lead removal
- 33243 describes thoracotomy removal of implantable defibrillator electrode(s). This code is for permanent pacemaker electrode(s).
33236 billing questions
How does this differ from 33234 or 33235?
This code describes pacemaker electrode removal through thoracotomy. Codes 33234 and 33235 describe transvenous removal, with the applicable code depending on the lead system.
When should I compare this with 33237?
Use 33236 for electrode removal through thoracotomy without removal of the pulse generator. Compare 33237 when the generator and electrode(s) are removed through thoracotomy.
What documentation supports reporting this code?
The operative report should identify the permanent pacemaker electrode(s) removed and document that removal was performed through thoracotomy.
Can an assistant-at-surgery be reported?
Assistant-at-surgery payment is available only when the record documents medical necessity for the assistant.
Can two surgeons report this service?
Co-surgeons are permitted. Team-surgery billing is not permitted for this code.
How does the global period affect postoperative care?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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