No office rate
33234 is for transvenous removal of a pacemaker electrode in a single-lead system. Use 33238 for the thoracotomy-based removal service.
On this page
CMS RVU26D · Effective 2026-10-01
33238 Pacing lead removal Medicare reimbursement rates in Tennessee
Reports surgical removal of a permanent pacing electrode through a thoracotomy, rather than extraction of a pacemaker lead through the venous route. Compare 33238 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 33238 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
$852.86
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 surgery
About 33238: Epicardial pacing lead removal by thoracotomy
Reports surgical removal of a permanent pacing electrode through a thoracotomy, rather than extraction of a pacemaker lead through the venous route.
This service removes a permanent pacemaker electrode through an open chest approach. It is generally performed by a cardiac surgeon when the lead is accessible from the chest or cannot be removed using a transvenous extraction approach. The work concerns the pacing electrode, not simply removal of the pulse generator. The procedure is typically performed in a hospital operating room.
Report 33238 when the documented lead-removal procedure matches this thoracotomy-based service; distinguish it from transvenous pacemaker lead extraction and from removal of implantable defibrillator electrodes. The operative report should identify the device and electrode removed, the surgical approach, and the reason for removal. This major surgery has a 90-day global period, including the day-before preoperative visit and 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 reduction. Modifier 50 is not appropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons are permitted, while team surgery is not permitted.
CMS billing rules for 33238
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU15.02 · 54%
- Practice expense (office) RVU9.44 · 34%
- Malpractice RVU3.60 · 13%
62
Medicare services in 2024 · #5220 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.
33238 compared with similar codes
Office rates for Tennessee, from the same CMS release.
No office rate
33235 describes transvenous pacemaker electrode removal in a dual-lead system; 33238 describes removal through a thoracotomy.
No office rate
33243 is for thoracotomy-based removal of implantable defibrillator electrode(s). 33238 is the related pacing-electrode service.
No office rate
33244 removes implantable defibrillator electrode(s) transvenously. The device type and surgical approach distinguish it from 33238.
Compare 33238 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
$852.86
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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 33238 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
3,867
- Code
- 33238
- Physician work
- 15.02
- Practice expense
- 9.44
- Malpractice
- 3.60
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.02 | × 1.000 | 15.0200 |
| Practice expense | 9.44 | × 0.909 | 8.5810 |
| Malpractice | 3.60 | × 0.537 | 1.9332 |
| Total RVUs | 25.5342 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$852.86
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.02 | 1 |
| Practice expense | 9.44 | 0.909 |
| Malpractice | 3.6 | 0.537 |
(15.02 × 1 + 9.44 × 0.909 + 3.6 × 0.537) × $33.4009 = $852.86
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.
33238 billing questions
How does 33238 differ from transvenous pacemaker lead removal?
33238 describes removal through a thoracotomy. Codes 33234 and 33235 describe transvenous removal of pacemaker electrodes, with the applicable code depending on the lead system.
Is 33238 for the generator or the electrode?
It is for electrode removal. Do not use it for removal of a pulse generator alone.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this service; report the procedure without a bilateral adjustment.
When can an assistant surgeon be paid?
Assistant-at-surgery payment is available only when the record documents medical necessity for the assistant.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care.
Can co-surgeons report this procedure?
Co-surgeons are permitted. Team surgery is not permitted for this code.
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.
3,86433235,,Removal pacemaker electrode,A,,9.65,5.07,NA,5.07,,2.28,17.00,17.00,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,86533236,,Remove electrode/thoracotomy,A,,12.41,7.92,NA,7.92,,2.97,23.30,23.30,0,090,0.09,0.84,0.07,2,0,0,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,86633237,,Remove electrode/thoracotomy,A,,13.49,8.15,NA,8.15,,3.22,24.86,24.86,0,090,0.09,0.84,0.07,2,0,0,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,86733238,,Remove electrode/thoracotomy,A,,15.02,9.44,NA,9.44,,3.60,28.06,28.06,0,090,0.09,0.84,0.07,2,0,0,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,8683323F,,Clin node stgng docdb/4 surg,I,,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
3,86933240,,Insrt pulse gen w/singl lead,A,,5.66,2.59,NA,2.59,,1.34,9.59,9.59,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,87033241,,Remove pulse generator,A,,2.96,2.26,NA,2.26,,0.70,5.92,5.92,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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