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Billing code 33231: Defibrillator generatorMedicare rate & RVUs

Reports placement of an implantable defibrillator pulse generator connected to multiple existing leads, without placement of a new lead system.

CMS RVU26DEffective Oct 1, 2026109 payment localities85 Medicare services in 2024

Medicare pays $355.05 for 33231 nationally in a facility.

Medicare rate · 33231

Defibrillator generator

Swap in your local Medicare rate.

Work RVUs
6.18
Total RVUs
10.63
Global days
090

National rate · 2026

$355.05

Facility setting, before claim adjustments.

See every locality for 33231 → · 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 33231 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 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.

Where 33231 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

33231 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$321.51
Alaska*Unavailable$443.03
ArizonaUnavailable$344.97
ArkansasUnavailable$317.43
AtlantaUnavailable$367.01
AustinUnavailable$355.75
BakersfieldUnavailable$349.66
Baltimore/Surr. CntysUnavailable$377.15
BeaumontUnavailable$342.59
BrazoriaUnavailable$345.15

33231 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
33231 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 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

Swap in your local Medicare rate.

Work 6.18Practice expense 3.00Malpractice 1.45

10.6300 adjusted RVUs×$33.4009 conversion factor=$355.05

All indexes start 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

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 · 33231

Defibrillator generator

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

33231 without 51 · national facility

$355.05

Defibrillator generator

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%).

When to use modifier 51

33231 compared with similar codes

Compare codes

33231 vs 33230 vs 33240 vs 33264 vs 33249: national Medicare rates

Swap in your local Medicare rate.

  • 33231
    Defibrillator generator · 6.18 wRVU
    —
  • 33230
    ICD generator · 5.92 wRVU
    —
  • 33240
    Defibrillator generator · 5.66 wRVU
    —
  • 33264
    ICD generator replacement · 6.19 wRVU
    —
  • 33249
    Defibrillator implant · 14.55 wRVU
    —

How to choose

33230ICD generator
Use 33230 for the defibrillator generator procedure with an existing dual-lead configuration; use 33231 when multiple existing leads are involved.
33240Defibrillator generator
33240 is the single-lead defibrillator generator option. This code represents the multiple-lead configuration.
33264ICD generator replacement
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 implant
33249 is for an insertion or replacement procedure involving the transvenous defibrillator system and lead work, rather than generator placement connected to existing leads.

Codes related to 33231

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

Codes related to 33231
CodeHow it relatesNational office range
Same family
33230ICD generatorDefibrillator generator procedure with an existing dual-lead configuration.No office rate
33240Defibrillator generatorDefibrillator generator procedure with an existing single lead.No office rate
Used instead
33264ICD generator replacementRemoval and replacement of a defibrillator generator with multiple leads.No office rate
33249Defibrillator implantFor insertion or replacement of a transvenous defibrillator system with lead work.No office rate
33229Pacemaker replacementMultiple-lead generator removal and replacement for a pacemaker rather than a defibrillator.No office rate

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
RVUs for 33231PPRRVU2026_Oct_nonQPP.csv, line 3,861 (RVU26D)

Open CMS sourceHow we calculate rates

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