Billing code 33203: Epicardial leadMedicare rate & RVUs in Ohio
Reports endoscopic placement of epicardial pacing electrode(s), typically by a thoracoscopic approach when a lead is placed on the heart’s surface.
CMS doesn’t publish an office rate for 33203 in Ohio.
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 33203 covers
This service places one or more pacing electrodes on the heart’s outer surface through an endoscopic approach, commonly thoracoscopic. It may be selected when epicardial pacing is needed and a transvenous route is unsuitable, such as in some patients with congenital heart disease or limited venous access. A cardiac or thoracic surgeon typically performs the procedure in an operating room or other facility setting.
Report 33203 for endoscopic epicardial electrode placement, rather than 33202 when the electrodes are placed through an open approach. The operative report should identify the endoscopic approach, the electrode placement, and the clinical reason for epicardial pacing. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of 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 50% multiple procedure reduction. Modifier 50 is inappropriate for this service. CMS does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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.
33203 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $754.59 |
How the 33203 rate is calculated
Each of 33203’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 · 33203
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 13.62Practice expense 6.04Malpractice 3.43
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 33203
33203 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33203
Epicardial lead
| 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 · 33203
Epicardial lead
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
33203 without 51 · national facility
$771.23
Epicardial lead
33203-51 · Second procedure: 50%
$385.62
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%).
33203 compared with similar codes
Compare codes
33203 vs 33202 vs 33206 vs 33208: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 33202Epicardial lead
- Both describe epicardial electrode placement. Choose 33203 for an endoscopic approach and 33202 for an open approach.
- 33206Pacemaker implant
- 33206 describes permanent pacemaker insertion using a transvenous atrial electrode; 33203 describes endoscopic placement of epicardial electrode(s).
- 33208Pacemaker implant
- 33208 describes transvenous permanent pacemaker insertion with atrial and ventricular electrodes, rather than endoscopic epicardial electrode placement.
33203 billing questions
How is 33203 distinguished from 33202?
Use 33203 when epicardial electrode placement is performed endoscopically. Code 33202 is the open approach.
Is this code for a transvenous pacemaker lead?
No. It describes endoscopic placement of an electrode on the heart’s outer surface; transvenous pacemaker system procedures have different codes.
What documentation supports reporting 33203?
The operative report should establish that the electrode was placed epicardially using an endoscopic approach and document the procedure performed.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this service, so modifier 50 should not be used.
How are assistant and co-surgeon services handled?
CMS does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing are 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 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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