Billing code 33228: Pacemaker generator exchangeMedicare rate & RVUs in Texas
Report this service when a physician removes and replaces the pulse generator of an existing permanent pacemaker with a dual-lead configuration.
CMS doesn’t publish an office rate for 33228 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 33228 covers
The physician removes a depleted or malfunctioning pulse generator from an existing permanent pacemaker system and connects a replacement while retaining the dual-lead configuration. A cardiologist or electrophysiologist typically performs the procedure in a cardiac catheterization or electrophysiology lab when the generator reaches battery end of service or needs replacement for another documented reason.
Select this code based on the existing system’s dual-lead configuration and an actual generator exchange, not on the number of leads newly implanted. The operative report should identify the existing system, generator removal and replacement, and lead configuration; generator removal is included in the exchange. CMS assigns a 90-day major-surgery global period, including 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%. 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.
Where 33228 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 | $316.18 |
| Beaumont | Unavailable | $303.91 |
| Brazoria | Unavailable | $306.50 |
| Dallas | Unavailable | $310.48 |
| Fort Worth | Unavailable | $310.11 |
| Galveston | Unavailable | $308.74 |
| Houston | Unavailable | $332.17 |
| Rest Of Texas | Unavailable | $306.42 |
How the 33228 rate is calculated
Each of 33228’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 · 33228
RVUs × geographic indexes × conversion factor
Work5.38
5.38 RVUs× 1.000 GPCI
Practice expense2.78
2.78 RVUs× 1.000 GPCI
Malpractice1.28
1.28 RVUs× 1.000 GPCI
Adjusted RVUs
9.4400
Conversion factor
$33.4009
Medicare rate
$315.30
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33228
33228 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33228
Pacemaker generator exchange
| 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 · 33228
Pacemaker generator exchange
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
33228 without 51 · national facility
$315.30
Pacemaker generator exchange
33228-51 · Second procedure: 50%
$157.65
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%).
33228 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33227Pacemaker generator exchange
- Use 33227 for exchange in a single-lead pacemaker system; 33228 is for an existing dual-lead system.
- 33229Pacemaker replacement
- Use 33229 for exchange in a multiple-lead pacemaker system. The dual-lead configuration points to 33228.
- 33230ICD generator
- 33230 describes insertion of a pulse generator with dual leads, rather than replacement of a generator in an existing dual-lead system.
- 33233Pacemaker generator removal
- 33233 is for generator removal without the replacement included in 33228.
33228 billing questions
How does 33228 differ from the single- and multiple-lead exchange codes?
33228 is for exchange of a generator in an existing dual-lead system. Use 33227 for a single-lead system and 33229 for a system with multiple leads.
Can the generator removal be reported separately?
No. Removal of the existing generator is part of the exchange reported with 33228.
What documentation supports 33228?
The operative report should establish that the existing pacemaker generator was removed and replaced and identify the system as dual-lead.
Is 33228 used for a new dual-lead pacemaker implant?
No. It describes exchange of a generator in an existing system. Code 33230 describes insertion of a pulse generator with dual leads.
What Medicare surgical payment rules affect this service?
It has a 90-day global period, and same-session multiple procedures are subject to the standard reduction: the highest-valued procedure is paid in full and others at 50%. Medicare does not pay an assistant at surgery, and 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
Fee sheets
Put 33228 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →