No office rate
Use 33227 for exchange in a single-lead pacemaker system; 33228 is for an existing dual-lead system.
On this page
CMS RVU26D · Effective 2026-10-01
33228 Pacemaker generator exchange Medicare reimbursement rates in Virginia
Report this service when a physician removes and replaces the pulse generator of an existing permanent pacemaker with a dual-lead configuration. Compare 33228 office and facility rates across CMS payment localities in Virginia.
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 33228 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$301.16–$346.37
2 of 2 localities have a supported rate.
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 33228: Dual-lead pacemaker generator exchange
Report this service when a physician removes and replaces the pulse generator of an existing permanent pacemaker with a dual-lead configuration.
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.
CMS billing rules for 33228
- 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 RVU5.38 · 57%
- Practice expense (office) RVU2.78 · 29%
- Malpractice RVU1.28 · 14%
31.6K
Medicare services in 2024 · #953 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.
33228 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
Use 33229 for exchange in a multiple-lead pacemaker system. The dual-lead configuration points to 33228.
No office rate
33230 describes insertion of a pulse generator with dual leads, rather than replacement of a generator in an existing dual-lead system.
No office rate
33233 is for generator removal without the replacement included in 33228.
Compare 33228 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$346.37
Virginia →
Office / nonfacility
Unavailable
Facility
$301.16
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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 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.
3,85433225,,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
3,86033230,,Insrt pulse gen w/dual leads,A,,5.92,2.64,NA,2.64,,1.41,9.97,9.97,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00