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CPT code 33230: ICD generator, existing dual leads2026 Medicare rate & RVUs

Reports insertion of an implantable defibrillator pulse generator when two compatible leads are already in place and the leads are connected to the new generator.

CMS RVU26DEffective Oct 1, 2026109 payment localities78 Medicare services in 2024

Medicare pays $333.01 for 33230 nationally in a facility.

Medicare rate · 33230

ICD generator, existing dual leads

Office or facility?

Work RVUs
5.92
Total RVUs
9.97
Global days
090

National rate · 2026

$333.01

Facility setting, before claim adjustments.

See every locality for 33230 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 33230 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 33230 covers

An electrophysiologist or other qualified cardiac device physician places an implantable cardioverter-defibrillator (ICD) pulse generator and connects it to two leads already in the patient. The procedure is performed in a hospital or other facility equipped for cardiac device implantation. It covers the generator work, not placement of new leads or implantation of an entire new transvenous ICD system.

Select this code when the documented service is generator insertion for an existing dual-lead system. The operative report should establish that two leads were present and connected to the new generator; a procedure that adds leads or implants the complete system is a different service. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during the 90 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this procedure, and 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 33230 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

33230 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$301.55
AlaskaUnavailable$416.46
ArizonaUnavailable$323.49
ArkansasUnavailable$297.73
Atlanta, GAUnavailable$344.48
Austin, TXUnavailable$333.15
Bakersfield, CAUnavailable$326.81
Baltimore area, MDUnavailable$353.77
Beaumont, TXUnavailable$321.73
Brazoria, TXUnavailable$323.43

33230 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
33230 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 33230 rate is calculated

Each of 33230’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 · 33230

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.92

5.92 RVUs× 1.000 GPCI

Practice expense2.64

2.64 RVUs× 1.000 GPCI

Malpractice1.41

1.41 RVUs× 1.000 GPCI

Adjusted RVUs

9.9700

Conversion factor

$33.4009

Medicare rate

$333.01

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 33230

33230 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33230

ICD generator, existing dual leads

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 33230

ICD generator, existing dual leads

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

33230 without 51 · national facility

$333.01

ICD generator, existing dual leads

33230-51 · Second procedure: 50%

$166.51

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%).

When to use modifier 51

33230 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 33230

    ICD generator, existing dual leads5.92 wRVU

    Not priced

  • 33231

    Defibrillator generator, multiple existing leads6.18 wRVU

    Not priced

  • 33240

    Defibrillator generator, single existing lead5.66 wRVU

    Not priced

  • 33249

    Defibrillator implant, complete transvenous system14.55 wRVU

    Not priced

How to choose

33231Defibrillator generatorMultiple existing leads
Choose 33230 when the existing system has two leads; choose 33231 when it has multiple leads.
33240Defibrillator generatorSingle existing lead
33240 applies to a single-lead defibrillator system. Code 33230 is for two existing leads.
33249Defibrillator implantComplete transvenous system
33230 covers generator insertion with existing leads; 33249 covers implantation or replacement of the complete transvenous ICD system.

Codes related to 33230

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 33230
CodeHow it relatesNational office range
Same family
33231Defibrillator generator, multiple existing leadsGenerator-only insertion for an existing system with multiple leads.No office rate
33240Defibrillator generator, single existing leadGenerator-only service for a single-lead defibrillator system.No office rate
Used instead
33249Defibrillator implant, complete transvenous systemFor implantation or replacement of the complete transvenous defibrillator system.No office rate

33230 billing questions

When is 33230 chosen instead of 33231?

Use 33230 for generator insertion with two existing leads. Code 33231 is for an existing system with multiple leads.

Does 33230 include placement of new leads?

No. It covers placement of the generator and connection to two existing leads. Report a different service when new leads are inserted.

How does 33230 differ from 33249?

33230 is generator-only work with existing dual leads. Code 33249 describes implantation or replacement of the complete transvenous ICD system.

What documentation supports the dual-lead selection?

The operative report should identify the generator insertion and establish that two existing leads were connected to it.

Can modifier 50 be appended for bilateral work?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this device procedure.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full; other procedures in the same session 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
RVUs for 33230PPRRVU2026_Oct_nonQPP.csv, line 3,860 (RVU26D)

Open CMS sourceHow we calculate rates

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