No office rate
33228 applies when the exchanged generator is part of a dual-lead pacemaker system; 33227 is for a single-lead system.
On this page
CMS RVU26D · Effective 2026-10-01
33227 Pacemaker generator exchange Medicare reimbursement rates in Tennessee
Report this service when a physician removes and replaces a permanent pacemaker generator while retaining the existing single-lead pacing system. Compare 33227 office and facility rates across CMS payment localities in Tennessee.
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 33227 in Tennessee?
Tennessee has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$274.99
1 of 1 localities have a supported rate.
Payment area: Tennessee
One mapped payment locality.
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.
Cardiac device procedures
About 33227: Single-lead pacemaker generator replacement
Report this service when a physician removes and replaces a permanent pacemaker generator while retaining the existing single-lead pacing system.
An electrophysiologist or other qualified physician opens the pacemaker pocket, disconnects the depleted or malfunctioning pulse generator from the existing pacing lead, attaches a replacement generator, and closes the pocket. This exchange is commonly performed in a hospital or outpatient facility when the generator reaches its replacement point or fails; the existing single-lead system remains in place.
Select the code based on the pacemaker system’s lead count, not simply the generator’s age or the reason for exchange. Documentation should identify the existing single-lead system, the generator removed and implanted, and the reason for replacement. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this single-generator service. CMS does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 33227
- 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 RVU5.12 · 57%
- Practice expense (office) RVU2.71 · 30%
- Malpractice RVU1.21 · 13%
2.1K
Medicare services in 2024 · #2441 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.
33227 compared with similar codes
Office rates for Tennessee, from the same CMS release.
No office rate
33229 is the generator-exchange code for a multiple-lead pacemaker system, rather than the single-lead system reported with 33227.
No office rate
33233 describes pacemaker generator removal without replacement. When a new generator is implanted during the same exchange, use the applicable replacement code instead.
No office rate
33214 describes an upgrade of the pacemaker system. Use 33227 when the service is a generator exchange that retains the existing single-lead configuration.
Compare 33227 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.
1 of 1 payment localities
Tennessee →
Office / nonfacility
Unavailable
Facility
$274.99
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 33227 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
3,856
- Code
- 33227
- Physician work
- 5.12
- Practice expense
- 2.71
- Malpractice
- 1.21
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.12 | × 1.000 | 5.1200 |
| Practice expense | 2.71 | × 0.909 | 2.4634 |
| Malpractice | 1.21 | × 0.537 | 0.6498 |
| Total RVUs | 8.2332 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$274.99
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.12 | 1 |
| Practice expense | 2.71 | 0.909 |
| Malpractice | 1.21 | 0.537 |
(5.12 × 1 + 2.71 × 0.909 + 1.21 × 0.537) × $33.4009 = $274.99
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
33227 billing questions
How is this code distinguished from 33228?
Use 33227 for replacement of a generator in a single-lead pacemaker system. Code 33228 is for a dual-lead system.
Is removal of the old generator included?
Yes. The service includes removing the existing generator as part of the exchange; do not separately report generator removal for that same exchange.
What documentation supports the single-lead selection?
Document the pacemaker configuration and the lead count, along with the generator removed, replacement generator, and reason for the exchange.
Should modifier 50 be reported?
No. Modifier 50 is inappropriate for this single-generator exchange.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for this code. Co-surgeon and team-surgery reporting 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 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.
3,85333224,,Insert pacing lead & connect,A,,8.81,2.33,NA,2.33,,2.08,13.22,13.22,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85433225,,L ventric pacing lead add-on,A,,8.12,1.78,NA,1.78,,1.91,11.81,11.81,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85533226,,Reposition l ventric lead,A,,8.46,2.20,NA,2.20,,2.01,12.67,12.67,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85633227,,Remove&replace pm gen singl,A,,5.12,2.71,NA,2.71,,1.21,9.04,9.04,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85733228,,Remv&replc pm gen dual lead,A,,5.38,2.78,NA,2.78,,1.28,9.44,9.44,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85833229,,Remv&replc pm gen mult leads,A,,5.65,2.89,NA,2.89,,1.33,9.87,9.87,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,8593322F,,Melanomaajcc stage 0 or ia,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780