CPT code 33233: Pacemaker generator removal2026 Medicare rate & RVUs in Rhode Island
Removal of an implanted pacemaker pulse generator without replacement, commonly for infection, malfunction, or when pacing therapy is no longer needed.
CMS doesn’t publish an office rate for 33233 in Rhode Island.
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 33233 covers
Code 33233 covers surgical removal of the pulse generator from an implanted permanent pacemaker; it does not represent removal of the pacing leads. A cardiologist, electrophysiologist, or cardiac surgeon typically opens the generator pocket, disconnects the generator, and removes it in a hospital operating room or electrophysiology setting. Common reasons include pocket or device infection, generator malfunction, or a decision to discontinue pacing. When a new pacemaker generator is implanted during the same procedure, use the applicable removal-and-replacement code instead.
Report the generator removal once, regardless of the number of connected leads. Documentation should identify the device as a pacemaker, the reason for removal, the generator-pocket procedure, and whether leads were retained or separately removed. Medicare classifies this as major surgery: the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are paid at 50%. Modifier 50 is inappropriate for this single-device procedure. 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.
33233 in Rhode Island
| Payment locality | Office | Facility |
|---|---|---|
| Rhode Island | Unavailable | $214.62 |
How the 33233 rate is calculated
Each of 33233’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 · 33233
RVUs × geographic indexes × conversion factor
Work3.06
3.06 RVUs× 1.000 GPCI
Practice expense2.58
2.58 RVUs× 1.000 GPCI
Malpractice0.72
0.72 RVUs× 1.000 GPCI
Adjusted RVUs
6.3600
Conversion factor
$33.4009
Medicare rate
$212.43
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33233
33233 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33233
Pacemaker generator 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) | 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 · 33233
Pacemaker generator 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
33233 without 51 · national facility
$212.43
Pacemaker generator removal
33233-51 · Second procedure: 50%
$106.22
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%).
33233 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33227Pacemaker generator exchange
- Use 33227 when a pacemaker generator is removed and replaced in a single-lead system; 33233 describes removal without replacement.
- 33228Pacemaker generator exchange
- Use 33228 for removal and replacement of a pacemaker generator in a dual-lead system. Generator removal alone is reported with 33233.
- 33234Pacemaker lead removal
- 33234 represents removal of transvenous pacing electrode(s) in a single-lead system, not removal of the generator.
- 33241ICD generator removal
- 33241 is for removal of an implantable defibrillator pulse generator; 33233 is for a permanent pacemaker generator.
33233 billing questions
When should 33233 be used instead of 33227, 33228, or 33229?
Use 33233 when the pacemaker generator is removed without a replacement generator being implanted. When the generator is replaced, select the applicable code based on the lead configuration.
Does 33233 include removal of the pacing leads?
No. This code represents removal of the pacemaker generator. When transvenous pacing leads are also removed, report the applicable lead-removal service for the work performed.
Can 33233 be reported with a lead-removal code?
It may be reported with a separately performed lead-removal service when the generator and leads are both removed. The record should distinguish the generator-pocket work from the lead extraction.
How many units should be reported when the pacemaker has multiple leads?
Report one unit for removal of the generator; the number of connected leads does not change the unit count for 33233.
Is modifier 50 appropriate for 33233?
No. Modifier 50 is inappropriate for removal of a single implanted generator from its pocket.
What documentation supports 33233?
Document that the device is a permanent pacemaker, why the generator was removed, the generator-pocket procedure, and whether the generator was replaced or the leads were separately removed.
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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