No office rate
Both concern ICD lead removal, but 33243 uses a thoracotomy approach and 33244 uses transvenous extraction.
On this page
CMS RVU26D · Effective 2026-10-01
33243 ICD lead removal Medicare reimbursement rates
Reports surgical removal of an implantable defibrillator lead through a thoracotomy, rather than removal by transvenous extraction. Compare 33243 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 33243?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 33243 pays more and less
Cardiac device surgery
About 33243: Defibrillator lead removal by thoracotomy
Reports surgical removal of an implantable defibrillator lead through a thoracotomy, rather than removal by transvenous extraction.
This service removes an implantable cardioverter-defibrillator (ICD) lead through an open chest approach. It is performed in an operating room, typically by a cardiac surgeon or cardiothoracic surgeon, when the lead is removed surgically rather than extracted through the veins. The code represents lead removal; removal of the pulse generator is a separate service. The transvenous extraction approach is reported with a different code.
Select this code when the operative report documents thoracotomy access and removal of an ICD lead. Documentation should identify the device and lead removed, the surgical approach, and any separately performed generator removal. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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 multiple-procedure reduction. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted. Modifier 50 is not appropriate.
CMS billing rules for 33243
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU22.98 · 59%
- Practice expense (office) RVU10.42 · 27%
- Malpractice RVU5.61 · 14%
233
Medicare services in 2024 · #4191 by national volume
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.
33243 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
33241 reports removal of the ICD pulse generator; 33243 reports removal of an ICD lead through thoracotomy.
No office rate
33236 is for pacemaker electrode removal through thoracotomy. Use 33243 for an ICD lead removed by that approach.
See how rates vary across the country
33243 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 33243 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1178.14 |
| Alaska* | Office Unavailable | Facility $1625.23 |
| Arizona | Office Unavailable | Facility $1265.20 |
| Arkansas | Office Unavailable | Facility $1163.02 |
| Atlanta | Office Unavailable | Facility $1348.50 |
| Austin | Office Unavailable | Facility $1303.33 |
| Bakersfield | Office Unavailable | Facility $1277.70 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $1385.07 |
| Beaumont | Office Unavailable | Facility $1258.34 |
| Brazoria | Office Unavailable | Facility $1264.75 |
| Chicago | Office Unavailable | Facility $1552.74 |
| Chico | Office Unavailable | Facility $1262.49 |
| Colorado | Office Unavailable | Facility $1293.42 |
| Connecticut | Office Unavailable | Facility $1384.47 |
| Dallas | Office Unavailable | Facility $1281.88 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $1427.54 |
| Delaware | Office Unavailable | Facility $1283.71 |
| Detroit | Office Unavailable | Facility $1419.33 |
| East St. Louis | Office Unavailable | Facility $1465.13 |
| El Centro | Office Unavailable | Facility $1263.42 |
| Fort Lauderdale | Office Unavailable | Facility $1458.90 |
| Fort Worth | Office Unavailable | Facility $1280.83 |
| Fresno | Office Unavailable | Facility $1262.49 |
| Galveston | Office Unavailable | Facility $1274.44 |
| Hanford-Corcoran | Office Unavailable | Facility $1262.49 |
| Hawaii, Guam | Office Unavailable | Facility $1271.76 |
| Houston | Office Unavailable | Facility $1377.13 |
| Idaho | Office Unavailable | Facility $1176.38 |
| Indiana | Office Unavailable | Facility $1181.25 |
| Iowa | Office Unavailable | Facility $1160.40 |
| Kansas | Office Unavailable | Facility $1176.62 |
| Kentucky | Office Unavailable | Facility $1248.41 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1335.17 |
| Madera | Office Unavailable | Facility $1262.49 |
| Manhattan | Office Unavailable | Facility $1518.28 |
| Merced | Office Unavailable | Facility $1262.49 |
| Metropolitan Boston | Office Unavailable | Facility $1381.35 |
| Metropolitan Kansas City | Office Unavailable | Facility $1277.43 |
| Metropolitan Philadelphia | Office Unavailable | Facility $1367.22 |
| Metropolitan St. Louis | Office Unavailable | Facility $1286.64 |
| Miami | Office Unavailable | Facility $1603.74 |
| Minnesota | Office Unavailable | Facility $1181.15 |
| Mississippi | Office Unavailable | Facility $1205.69 |
| Modesto | Office Unavailable | Facility $1262.49 |
| Montana** | Office Unavailable | Facility $1302.59 |
| Napa | Office Unavailable | Facility $1369.81 |
| Nebraska | Office Unavailable | Facility $1159.62 |
| Nevada** | Office Unavailable | Facility $1272.02 |
| New Hampshire | Office Unavailable | Facility $1293.82 |
| New Mexico | Office Unavailable | Facility $1311.75 |
| New Orleans | Office Unavailable | Facility $1307.92 |
| North Carolina | Office Unavailable | Facility $1212.01 |
| North Dakota** | Office Unavailable | Facility $1191.67 |
| Northern Nj | Office Unavailable | Facility $1419.75 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $1578.46 |
| Ohio | Office Unavailable | Facility $1274.19 |
| Oklahoma | Office Unavailable | Facility $1223.94 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1317.16 |
| Portland | Office Unavailable | Facility $1305.91 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $1409.92 |
| Puerto Rico | Office Unavailable | Facility $1303.99 |
| Queens | Office Unavailable | Facility $1498.26 |
| Redding | Office Unavailable | Facility $1262.49 |
| Rest Of California | Office Unavailable | Facility $1262.49 |
| Rest Of Florida | Office Unavailable | Facility $1381.91 |
| Rest Of Georgia | Office Unavailable | Facility $1301.36 |
| Rest Of Illinois | Office Unavailable | Facility $1378.18 |
| Rest Of Louisiana | Office Unavailable | Facility $1255.07 |
| Rest Of Maine | Office Unavailable | Facility $1204.30 |
| Rest Of Maryland | Office Unavailable | Facility $1299.46 |
| Rest Of Massachusetts | Office Unavailable | Facility $1295.66 |
| Rest Of Michigan | Office Unavailable | Facility $1296.86 |
| Rest Of Missouri | Office Unavailable | Facility $1250.07 |
| Rest Of New Jersey | Office Unavailable | Facility $1383.87 |
| Rest Of New York | Office Unavailable | Facility $1229.92 |
| Rest Of Oregon | Office Unavailable | Facility $1245.93 |
| Rest Of Pennsylvania | Office Unavailable | Facility $1264.12 |
| Rest Of Texas | Office Unavailable | Facility $1267.04 |
| Rest Of Washington | Office Unavailable | Facility $1286.61 |
| Rhode Island | Office Unavailable | Facility $1308.80 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1322.65 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1300.39 |
| Salinas | Office Unavailable | Facility $1295.16 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1308.39 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1417.21 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1410.84 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1454.29 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1428.24 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1277.45 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1306.97 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1295.29 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1318.40 |
| Seattle (King Cnty) | Office Unavailable | Facility $1386.06 |
| South Carolina | Office Unavailable | Facility $1248.41 |
| South Dakota** | Office Unavailable | Facility $1178.55 |
| Southern Maine | Office Unavailable | Facility $1230.69 |
| Stockton | Office Unavailable | Facility $1262.49 |
| Suburban Chicago | Office Unavailable | Facility $1462.40 |
| Tennessee | Office Unavailable | Facility $1184.54 |
| Utah | Office Unavailable | Facility $1262.97 |
| Vallejo | Office Unavailable | Facility $1360.63 |
| Vermont | Office Unavailable | Facility $1206.92 |
| Virgin Islands | Office Unavailable | Facility $1303.99 |
| Virginia | Office Unavailable | Facility $1241.96 |
| Visalia | Office Unavailable | Facility $1262.49 |
| West Virginia | Office Unavailable | Facility $1338.14 |
| Wisconsin | Office Unavailable | Facility $1158.69 |
| Wyoming** | Office Unavailable | Facility $1254.25 |
| Yuba City | Office Unavailable | Facility $1262.49 |
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33243 billing questions
When should 33243 be used instead of 33244?
Use 33243 for removal of an ICD lead through thoracotomy. Use 33244 when the lead is removed by transvenous extraction.
Does 33243 include removal of the ICD generator?
No. This code represents lead removal; report generator removal separately when performed, using 33241.
Can 33241 be reported with 33243?
It may be reported when the ICD pulse generator is also removed during the encounter. The operative documentation should support both the generator removal and thoracotomy lead removal.
What documentation supports 33243?
Document the ICD lead removed and the thoracotomy approach. The operative report should distinguish this surgical removal from transvenous extraction.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Is modifier 50 appropriate?
No. Modifier 50 is not appropriate for this lead-removal service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,8683323F,,Clin node stgng docdb/4 surg,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3,86933240,,Insrt pulse gen w/singl lead,A,,5.66,2.59,NA,2.59,,1.34,9.59,9.59,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,87033241,,Remove pulse generator,A,,2.96,2.26,NA,2.26,,0.70,5.92,5.92,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,87133243,,Remove eltrd/thoracotomy,A,,22.98,10.42,NA,10.42,,5.61,39.01,39.01,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,87233244,,Remove elctrd transvenously,A,,13.40,6.37,NA,6.37,,3.18,22.95,22.95,0,090,0.09,0.84,0.07,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,87333249,,Insj/rplcmt defib w/lead(s),A,,14.55,5.91,NA,5.91,,3.43,23.89,23.89,0,090,0.09,0.84,0.07,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,8743324F,,Mri ct scan ord rvwd rqstd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00