No office rate
Choose 33213 for generator insertion with an existing dual-lead system. Use 33221 when the existing pacing system has multiple leads.
On this page
CMS RVU26D · Effective 2026-10-01
33221 Pacemaker generator Medicare reimbursement rates in Wyoming
Insertion of a pulse generator connected to an existing multiple-lead pacemaker system, typically when the leads remain in place and only the generator is implanted. Compare 33221 office and facility rates across CMS payment localities in Wyoming.
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 33221 in Wyoming?
Wyoming 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
$307.44
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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.
Cardiology procedure
About 33221: Multiple-lead pacemaker generator insertion
Insertion of a pulse generator connected to an existing multiple-lead pacemaker system, typically when the leads remain in place and only the generator is implanted.
Code 33221 describes placing a pacemaker pulse generator and connecting it to an existing multiple-lead pacing system. Electrophysiologists and other qualified cardiac surgeons commonly perform the procedure in a hospital operating room or electrophysiology setting. A typical clinical context is a multilead system, such as cardiac resynchronization pacing, whose leads are already in place and will be connected to the new generator.
Report 33221 when the procedure is limited to generator insertion with existing multiple leads; documentation should identify the existing leads and describe generator placement and connection. When the generator is removed and replaced, consider the replacement code for a multiple-lead system instead. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery are not permitted.
CMS billing rules for 33221
- 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 RVU5.41 · 57%
- Practice expense (office) RVU2.84 · 30%
- Malpractice RVU1.29 · 14%
167
Medicare services in 2024 · #4485 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.
33221 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
33229 describes removing and replacing a generator in a multiple-lead system. Code 33221 is for generator insertion without that removal-and-replacement service.
No office rate
33208 describes implantation of a new atrial-and-ventricular pacing system. Code 33221 applies when multiple leads are already present and the service is generator insertion.
Compare 33221 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
Wyoming** →
Office / nonfacility
Unavailable
Facility
$307.44
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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 33221 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
3,850
- Code
- 33221
- Physician work
- 5.41
- Practice expense
- 2.84
- Malpractice
- 1.29
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.41 | × 1.000 | 5.4100 |
| Practice expense | 2.84 | × 1.000 | 2.8400 |
| Malpractice | 1.29 | × 0.740 | 0.9546 |
| Total RVUs | 9.2046 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$307.44
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.41 | 1 |
| Practice expense | 2.84 | 1 |
| Malpractice | 1.29 | 0.74 |
(5.41 × 1 + 2.84 × 1 + 1.29 × 0.74) × $33.4009 = $307.44
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.
33221 billing questions
How is 33221 different from 33213?
33221 is for a generator connected to an existing multiple-lead system. Code 33213 is the generator-only choice for an existing dual-lead system.
Should 33221 be used when the generator is replaced?
Use the multiple-lead generator removal-and-replacement code, 33229, when the existing generator is removed and replaced. Code 33221 describes generator insertion rather than removal and replacement.
Does 33221 include placement of new leads?
It describes generator insertion with multiple leads already in place, not placement of new leads. The operative report should establish whether the leads were existing or newly implanted.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are other same-session procedures paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Assistant-at-surgery payment is statutorily restricted; co-surgeons and team surgery 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.
3,84733218,,Repair lead pace-defib one,A,,5.67,3.43,NA,3.43,,1.33,10.43,10.43,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,8483321F,,Ajcc cncr 0/ia melan docd,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
3,84933220,,Repair lead pace-defib dual,A,,5.75,3.11,NA,3.11,,1.36,10.22,10.22,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85033221,,Insert pulse gen mult leads,A,,5.41,2.84,NA,2.84,,1.29,9.54,9.54,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85133222,,Relocation pocket pacemaker,A,,4.73,3.44,NA,3.44,,1.12,9.29,9.29,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,85233223,,Relocate pocket for defib,A,,6.14,3.32,NA,3.32,,1.44,10.90,10.90,0,090,0.09,0.84,0.07,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,