CPT code 33231: Defibrillator generator, multiple existing leads2026 Medicare rate & RVUs in Guam
Reports placement of an implantable defibrillator pulse generator connected to multiple existing leads, without placement of a new lead system.
CMS doesn’t publish an office rate for 33231 in Guam.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 33231 covers
An electrophysiologist or other qualified cardiac surgeon places the defibrillator pulse generator and connects it to multiple leads already implanted in the heart. The procedure commonly takes place in a hospital electrophysiology lab or operating room. The work involves accessing the generator pocket, connecting the existing leads to the new generator, and assessing device function. This code represents generator work rather than placement of a new transvenous lead system.
Select this code when the operative report supports a defibrillator generator procedure with multiple existing leads; document the device type, lead configuration, and work performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Medicare does not pay an assistant at surgery for this service; co-surgeon and team-surgery reporting 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.
33231 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $348.39 |
How the 33231 rate is calculated
Each of 33231’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 · 33231
RVUs × geographic indexes × conversion factor
Work6.18
6.18 RVUs× 1.000 GPCI
Practice expense3.00
3.00 RVUs× 1.000 GPCI
Malpractice1.45
1.45 RVUs× 1.000 GPCI
Adjusted RVUs
10.6300
Conversion factor
$33.4009
Medicare rate
$355.05
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33231
33231 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33231
Defibrillator generator, multiple existing leads
| 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 · 33231
Defibrillator generator, multiple existing 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33231 without 51 · national facility
$355.05
Defibrillator generator, multiple existing leads
33231-51 · Second procedure: 50%
$177.53
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%).
33231 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 33230ICD generatorExisting dual leads
- Use 33230 for the defibrillator generator procedure with an existing dual-lead configuration; use 33231 when multiple existing leads are involved.
- 33240Defibrillator generatorSingle existing lead
- 33240 is the single-lead defibrillator generator option. This code represents the multiple-lead configuration.
- 33264ICD generator replacementMultiple lead system
- 33264 describes removal and replacement of a defibrillator generator with multiple leads. This code is for generator placement with multiple existing leads without that replacement service.
- 33249Defibrillator implantComplete transvenous system
- 33249 is for an insertion or replacement procedure involving the transvenous defibrillator system and lead work, rather than generator placement connected to existing leads.
33231 billing questions
How is this code distinguished from the single- or dual-lead generator codes?
Choose based on the existing lead configuration documented for the defibrillator generator procedure. The single-lead and dual-lead options describe different configurations; this code is for multiple existing leads.
Can this code be used when a new defibrillator lead is placed?
This code describes generator placement with multiple existing leads, not placement of a new lead system. When new transvenous leads are part of the procedure, evaluate the complete system code that matches the work performed.
How does this differ from generator removal and replacement?
This code reports placement of a defibrillator generator with multiple existing leads. Code 33264 describes removal and replacement of a defibrillator generator with multiple leads.
What documentation supports the multiple-lead selection?
The operative report should identify the defibrillator generator procedure and describe the existing lead configuration and connections. The documentation should make clear that multiple leads were connected to the generator.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, Medicare pays the highest-valued procedure in full and pays other procedures at 50% when performed in the same session.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery reporting 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
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