CPT code 33226: LV lead repositioning2026 Medicare rate & RVUs in Texas
Report 33226 when a previously implanted transvenous left ventricular pacing lead is repositioned to correct its location in a cardiac resynchronization system.
CMS doesn’t publish an office rate for 33226 in Texas.
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 33226 covers
An electrophysiologist or other cardiac-device implanting specialist repositions a transvenous lead used for left ventricular pacing, commonly in a cardiac resynchronization therapy system. The lead may need adjustment when its position has shifted or is not providing the intended pacing. The work is typically performed in a hospital electrophysiology or cardiac catheterization lab, with imaging used to guide lead manipulation.
Report 33226 for repositioning an existing left ventricular lead, rather than placing a new LV lead or repositioning a different pacing or defibrillator lead. The procedure note should identify the previously placed LV lead, the reason for revision, the repositioning performed, and its final position. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Medicare does not pay an assistant at surgery for this service; 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.
Where 33226 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $420.36 |
| Beaumont | Unavailable | $411.81 |
| Brazoria | Unavailable | $410.02 |
| Dallas | Unavailable | $415.91 |
| Fort Worth | Unavailable | $416.04 |
| Galveston | Unavailable | $413.39 |
| Houston | Unavailable | $450.18 |
| Rest Of Texas | Unavailable | $412.93 |
How the 33226 rate is calculated
Each of 33226’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 · 33226
RVUs × geographic indexes × conversion factor
Work8.46
8.46 RVUs× 1.000 GPCI
Practice expense2.20
2.20 RVUs× 1.000 GPCI
Malpractice2.01
2.01 RVUs× 1.000 GPCI
Adjusted RVUs
12.6700
Conversion factor
$33.4009
Medicare rate
$423.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33226
The CMS indicators that decide how 33226 is paid alongside other services.
CMS payment indicators · 33226
LV lead repositioning
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33226 without 51 · national facility
$423.19
LV lead repositioning
33226-51 · Second procedure: 50%
$211.60
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%).
33226 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33215Lead repositioning
- Use 33226 for repositioning a previously placed transvenous LV lead. Use 33215 for repositioning another type of transvenous pacemaker or defibrillator electrode.
- 33225LV pacing lead
- 33225 covers placement of an LV pacing lead as an add-on service. 33226 is for repositioning an LV lead that was already placed.
- 33224LV pacing lead
- 33224 describes insertion and connection of an LV pacing lead. Choose 33226 when the service is repositioning an existing LV lead instead of inserting one.
33226 billing questions
How does 33226 differ from 33215?
33226 is for repositioning a previously placed transvenous left ventricular lead. 33215 applies to repositioning a different transvenous pacemaker or defibrillator electrode.
Should 33226 be used for a newly placed LV lead?
No. It describes repositioning a previously placed LV lead. Code selection for a new lead depends on the insertion service performed.
What documentation supports 33226?
Document that the lead was previously implanted and identify it as the LV pacing lead. Include the reason for repositioning, the work performed, and the lead's final position.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
How is 33226 paid when other procedures occur in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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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