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Billing code 33223: Defibrillator pocketMedicare rate & RVUs

Reports surgical relocation of an existing implantable defibrillator generator pocket when the device is moved to a different pocket site.

CMS RVU26DEffective Oct 1, 2026109 payment localities859 Medicare services in 2024

Medicare pays $364.07 for 33223 nationally in a facility.

Medicare rate · 33223

Defibrillator pocket

Work RVUs
6.14
Total RVUs
10.90
Global days
090

National rate · 2026

$364.07

Facility setting, before claim adjustments.

See every locality for 33223 →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.

On this page 10 sections
  1. Medicare rate
  2. What 33223 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 33223 covers

The implanting physician opens the existing pocket, frees the defibrillator generator, creates a pocket in a different location, and places the generator there. This may be done when the current pocket causes discomfort or has inadequate tissue coverage. The procedure is typically performed by a cardiac electrophysiologist or other implanting specialist in a hospital or surgical facility; the generator is moved while the existing system’s leads generally remain in place.

Report 33223 when the operative work relocates the defibrillator pocket, rather than merely repositioning a lead or replacing the generator. Document the reason for relocation, the original and new pocket sites, and the work performed on the generator and leads. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed 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 not appropriate. Assistant-at-surgery payment requires documentation of medical necessity; 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 33223 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

33223 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$329.33
Alaska*Unavailable$452.22
ArizonaUnavailable$353.71
ArkansasUnavailable$325.11
AtlantaUnavailable$376.13
AustinUnavailable$365.43
BakersfieldUnavailable$359.81
Baltimore/Surr. CntysUnavailable$386.85
BeaumontUnavailable$350.67
BrazoriaUnavailable$354.13

33223 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
33223 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 33223 rate is calculated

Each of 33223’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 · 33223

RVUs × geographic indexes × conversion factor

Work6.14

6.14 RVUs× 1.000 GPCI

Practice expense3.32

3.32 RVUs× 1.000 GPCI

Malpractice1.44

1.44 RVUs× 1.000 GPCI

Adjusted RVUs

10.9000

Conversion factor

$33.4009

Medicare rate

$364.07

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

Payment rules and modifiers for 33223

33223 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33223

Defibrillator pocket

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)0Not paid without supporting documentation.
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 · 33223

Defibrillator pocket

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

33223 without 51 · national facility

$364.07

Defibrillator pocket

33223-51 · Second procedure: 50%

$182.04

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

33223 compared with similar codes

Compare codes · National

4 codes, side by side

  • 33223

    Defibrillator pocket6.14 wRVU

    Not priced

  • 33222

    Pocket relocation4.73 wRVU

    Not priced

  • 33215

    Lead repositioning4.8 wRVU

    Not priced

  • 33249

    Defibrillator implant14.55 wRVU

    Not priced

How to choose

33222Pocket relocation
33222 is for relocation of a pacemaker pocket; 33223 is for relocation of an implantable defibrillator pocket.
33215Lead repositioning
Choose 33215 for repositioning a pacing-defibrillator lead. Choose 33223 when the generator pocket itself is moved.
33249Defibrillator implant
33249 describes implantation or replacement of a transvenous defibrillator system; 33223 describes relocation of an existing generator pocket.

Codes related to 33223

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

Codes related to 33223
CodeHow it relatesNational office range
Same family
33222Pocket relocationRelocates a pacemaker pocket rather than an implantable defibrillator pocket.No office rate
Often billed with
33215Lead repositioningMay be reported in the same encounter when lead repositioning is a distinct procedure.No office rate
33249Defibrillator implantDefibrillator system implantation may occur in the same session when separately performed.No office rate

33223 billing questions

How is pocket relocation different from defibrillator lead repositioning?

33223 describes moving the generator pocket to a different site. Use 33215 when the work repositions a pacing-defibrillator lead rather than relocating the pocket.

Can 33223 be reported when the generator is replaced?

The defining work is relocating the pocket, not replacing the generator. Document the pocket relocation separately from any generator replacement performed during the encounter.

What documentation supports 33223?

Document the clinical reason for changing the pocket site, its prior and new locations, and the operative steps used to move the generator. Describe any separate lead or generator work as well.

What global period applies?

33223 has a 90-day global period. The day-before preoperative visit and related postoperative care during that period are included.

When is assistant-at-surgery payment allowed?

CMS payment for an assistant at surgery requires documentation that the assistant was medically necessary. Co-surgeons and team surgery are not permitted for this code.

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 33223PPRRVU2026_Oct_nonQPP.csv, line 3,852 (RVU26D)

Open CMS sourceHow we calculate rates

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