FeeBase
Log inGet started
Menu

Billing code 33263: ICD generator exchangeMedicare rate & RVUs

Removal and replacement of an implantable cardioverter-defibrillator generator connected to an existing dual-lead system, commonly performed when the generator reaches replacement status.

CMS RVU26DEffective Oct 1, 2026109 payment localities6.1K Medicare services in 2024

Medicare pays $342.36 for 33263 nationally in a facility.

Medicare rate · 33263

ICD generator exchange

Swap in your local Medicare rate.

Work RVUs
5.93
Total RVUs
10.25
Global days
090

National rate · 2026

$342.36

Facility setting, before claim adjustments.

See every locality for 33263 → · 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 33263 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 33263 covers

This service replaces the pulse generator of an implanted cardioverter-defibrillator while retaining the existing dual-lead system. It is commonly performed when the generator reaches replacement status. Cardiologists and cardiac electrophysiologists typically perform the exchange in a hospital electrophysiology lab or other surgical facility. The dual-lead configuration distinguishes this service from generator exchanges for single-lead or multiple-lead systems.

Report the service when the operative documentation supports removal and replacement of the generator and identifies the dual-lead configuration. The record should describe the generator exchange and the disposition of the existing leads. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of 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 inappropriate. Medicare does not pay for an assistant at surgery; 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 33263 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

33263 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$309.87
Alaska*Unavailable$426.74
ArizonaUnavailable$332.60
ArkansasUnavailable$305.93
AtlantaUnavailable$353.91
AustinUnavailable$343.08
BakersfieldUnavailable$337.20
Baltimore/Surr. CntysUnavailable$363.73
BeaumontUnavailable$330.26
BrazoriaUnavailable$332.78

33263 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
33263 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 33263 rate is calculated

Each of 33263’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 · 33263

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.93Practice expense 2.92Malpractice 1.40

10.2500 adjusted RVUs×$33.4009 conversion factor=$342.36

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 33263

33263 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33263

ICD generator exchange

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 · 33263

ICD generator exchange

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

33263 without 51 · national facility

$342.36

ICD generator exchange

33263-51 · Second procedure: 50%

$171.18

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

33263 compared with similar codes

Compare codes

33263 vs 33262 vs 33264 vs 33249: national Medicare rates

Swap in your local Medicare rate.

  • 33263
    ICD generator exchange · 5.93 wRVU
    —
  • 33262
    Defibrillator exchange · 5.66 wRVU
    —
  • 33264
    ICD generator replacement · 6.19 wRVU
    —
  • 33249
    Defibrillator implant · 14.55 wRVU
    —

How to choose

33262Defibrillator exchange
Use 33262 for generator exchange in a single-lead ICD system. This code is for a dual-lead system.
33264ICD generator replacement
Use 33264 for generator exchange in a multiple-lead ICD system. This code identifies the dual-lead configuration.
33249Defibrillator implant
33249 describes insertion or replacement of an ICD system with transvenous leads. This code describes exchange of the generator in an existing dual-lead system.

Codes related to 33263

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

Codes related to 33263
CodeHow it relatesNational office range
Same family
33262Defibrillator exchangeGenerator removal and replacement for an ICD system with a single lead.No office rate
33264ICD generator replacementGenerator removal and replacement for an ICD system with multiple leads.No office rate
Used instead
33249Defibrillator implantUsed for insertion or replacement of an ICD system with transvenous leads, rather than a generator-only exchange.No office rate

33263 billing questions

How is this code distinguished from 33262 and 33264?

This code is for a dual-lead ICD system. Code 33262 describes a single-lead system, while 33264 describes a multiple-lead system.

Does this code describe replacing the leads as well as the generator?

It describes exchange of the ICD generator for an existing dual-lead system. If lead placement or revision is performed, document that work and determine the appropriate coding separately.

What documentation supports the dual-lead selection?

Document the generator removal and replacement and identify the existing system as dual-lead, including the status or disposition of those leads.

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.

Can an assistant or co-surgeon be reported?

Medicare does not pay for an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

How does Medicare handle other procedures performed in the same session?

The highest-valued procedure is paid in full, and other procedures performed in the same session are subject to the standard multiple-procedure reduction.

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 33263PPRRVU2026_Oct_nonQPP.csv, line 3,886 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 33263 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 33263 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →