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CPT code 33249: Defibrillator implant, complete transvenous system2026 Medicare rate & RVUs

Reports implantation or replacement of a complete transvenous implantable defibrillator system when the procedure includes placement of one or more leads.

CMS RVU26DEffective Oct 1, 2026109 payment localities28.8K Medicare services in 2024

Medicare pays $797.95 for 33249 nationally in a facility.

Medicare rate · 33249

Defibrillator implant, complete transvenous system

Office or facility?

Work RVUs
14.55
Total RVUs
23.89
Global days
090

National rate · 2026

$797.95

Facility setting, before claim adjustments.

See every locality for 33249 →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 33249 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 33249 covers

An electrophysiologist or cardiac surgeon places an implantable cardioverter-defibrillator (ICD) generator and transvenous lead or leads, commonly in a hospital electrophysiology lab. The leads pass through a vein into the heart, where the system can detect and treat dangerous ventricular rhythms with electrical therapy. Typical indications include prevention of sudden cardiac death in patients at risk of life-threatening ventricular arrhythmias, or treatment after a qualifying arrhythmic event.

Choose this code when the procedure involves the complete transvenous ICD system, including lead placement, rather than a generator-only service. The operative report should identify the indication, implanted generator, lead placement, and whether the procedure was an insertion or replacement. Medicare assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery services are not paid; co-surgeons require supporting documentation, and team surgery is 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 33249 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

33249 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$723.55
AlaskaUnavailable$1,002.33
ArizonaUnavailable$775.33
ArkansasUnavailable$714.55
Atlanta, GAUnavailable$825.59
Austin, TXUnavailable$797.31
Bakersfield, CAUnavailable$781.34
Baltimore area, MDUnavailable$847.29
Beaumont, TXUnavailable$772.05
Brazoria, TXUnavailable$774.85

33249 rates by state

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

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Explore a state

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
33249 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 33249 rate is calculated

Each of 33249’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 · 33249

RVUs × geographic indexes × conversion factor

Office or facility?

Work14.55

14.55 RVUs× 1.000 GPCI

Practice expense5.91

5.91 RVUs× 1.000 GPCI

Malpractice3.43

3.43 RVUs× 1.000 GPCI

Adjusted RVUs

23.8900

Conversion factor

$33.4009

Medicare rate

$797.95

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

Payment rules and modifiers for 33249

33249 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33249

Defibrillator implant, complete transvenous system

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)1Permitted with supporting documentation.
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 · 33249

Defibrillator implant, complete transvenous system

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

33249 without 51 · national facility

$797.95

Defibrillator implant, complete transvenous system

33249-51 · Second procedure: 50%

$398.98

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

33249 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 33249

    Defibrillator implant, complete transvenous system14.55 wRVU

    Not priced

  • 33240

    Defibrillator generator, single existing lead5.66 wRVU

    Not priced

  • 33263

    ICD generator exchange, dual-lead system5.93 wRVU

    Not priced

  • 33264

    ICD generator replacement, multiple lead system6.19 wRVU

    Not priced

How to choose

33240Defibrillator generatorSingle existing lead
33249 includes transvenous lead placement as part of the ICD system procedure. Use 33240 for the applicable generator-only service without lead placement.
33263ICD generator exchangeDual-lead system
33263 reports removal and replacement of a generator in a dual-lead ICD system when the leads are retained; 33249 includes transvenous lead placement.
33264ICD generator replacementMultiple lead system
33264 reports removal and replacement of a generator in a multiple-lead ICD system when the leads are retained; 33249 includes transvenous lead placement.

Codes related to 33249

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

Codes related to 33249
CodeHow it relatesNational office range
Used instead
33240Defibrillator generator, single existing leadGenerator-only service for a single-lead ICD system when transvenous lead placement is not part of the procedure.No office rate
33262Defibrillator exchange, single-lead systemGenerator removal and replacement for a single-lead ICD system when leads are retained.No office rate
33263ICD generator exchange, dual-lead systemGenerator removal and replacement for a dual-lead ICD system when leads are retained.No office rate
33264ICD generator replacement, multiple lead systemGenerator removal and replacement for a multiple-lead ICD system when leads are retained.No office rate

33249 billing questions

When should this code be used instead of a generator-only code?

Use 33249 when the procedure includes placement of transvenous lead(s) as part of the ICD system. A generator-only procedure without lead placement is represented by a different code.

Does this code cover a single- or dual-chamber system?

It covers a transvenous ICD system with one or more leads, including single- or dual-chamber configurations. Document the leads placed and the implanted system.

What documentation supports reporting 33249?

The operative report should establish the ICD indication and describe the generator and transvenous lead placement, including whether the system was newly implanted or replaced.

What postoperative care is included in the global period?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How are other procedures in the same session 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 services are not paid; co-surgeons require supporting documentation.

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 33249PPRRVU2026_Oct_nonQPP.csv, line 3,873 (RVU26D)

Open CMS sourceHow we calculate rates

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