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Billing code 33264: ICD generator replacementMedicare rate & RVUs

Reports removal and replacement of an implantable defibrillator pulse generator when the existing system has multiple leads, such as a CRT-D system.

CMS RVU26DEffective Oct 1, 2026109 payment localities12.7K Medicare services in 2024

Medicare pays $355.39 for 33264 nationally in a facility.

Medicare rate · 33264

ICD generator replacement

Swap in your local Medicare rate.

Work RVUs
6.19
Total RVUs
10.64
Global days
090

National rate · 2026

$355.39

Facility setting, before claim adjustments.

See every locality for 33264 → · 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 33264 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 33264 covers

An electrophysiologist or other qualified cardiac proceduralist removes the implanted defibrillator generator and connects a replacement to the existing multiple-lead system. Common indications include battery depletion or generator malfunction. The procedure is typically performed in a hospital electrophysiology lab or operating room; a system with atrial, right-ventricular, and left-ventricular leads is a familiar example. This code describes generator exchange, not implantation of a new lead system.

Select the code based on the existing system’s lead configuration: this multiple-lead code differs from the single- and dual-lead generator replacement codes. Document the device and lead configuration, reason for exchange, generator removal and replacement, and testing performed. The generator exchange includes a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur 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; assistant-at-surgery payment is restricted, and 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 33264 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

33264 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$321.74
Alaska*Unavailable$443.36
ArizonaUnavailable$345.27
ArkansasUnavailable$317.65
AtlantaUnavailable$367.41
AustinUnavailable$356.03
BakersfieldUnavailable$349.83
Baltimore/Surr. CntysUnavailable$377.54
BeaumontUnavailable$342.94
BrazoriaUnavailable$345.41

33264 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
33264 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 33264 rate is calculated

Each of 33264’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 · 33264

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 6.19Practice expense 2.99Malpractice 1.46

10.6400 adjusted RVUs×$33.4009 conversion factor=$355.39

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

Payment rules and modifiers for 33264

33264 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 33264

ICD generator replacement

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 · 33264

ICD generator replacement

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

33264 without 51 · national facility

$355.39

ICD generator replacement

33264-51 · Second procedure: 50%

$177.70

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

33264 compared with similar codes

Compare codes

33264 vs 33262 vs 33263 vs 33249 vs 33270: national Medicare rates

Swap in your local Medicare rate.

  • 33264
    ICD generator replacement · 6.19 wRVU
    —
  • 33262
    Defibrillator exchange · 5.66 wRVU
    —
  • 33263
    ICD generator exchange · 5.93 wRVU
    —
  • 33249
    Defibrillator implant · 14.55 wRVU
    —
  • 33270
    Defibrillator implant · 8.87 wRVU
    —

How to choose

33262Defibrillator exchange
Use 33262 for generator exchange in a single-lead ICD system; 33264 is for a multiple-lead system.
33263ICD generator exchange
Use 33263 for a dual-lead ICD system. Use 33264 when the documented system has multiple leads beyond that configuration.
33249Defibrillator implant
33264 describes exchange of the pulse generator while retaining the existing leads. 33249 is for insertion or replacement of a transvenous ICD system with lead work.
33270Defibrillator implant
33270 concerns a subcutaneous defibrillator system; 33264 is for generator exchange in a multiple-lead ICD system.

Codes related to 33264

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

Codes related to 33264
CodeHow it relatesNational office range
Same family
33262Defibrillator exchangeGenerator replacement for an ICD system with a single lead.No office rate
33263ICD generator exchangeGenerator replacement for an ICD system with two leads.No office rate
Used instead
33249Defibrillator implantUsed for insertion or replacement of a transvenous ICD system with lead work, rather than generator-only exchange.No office rate
33270Defibrillator implantPlacement or replacement of a subcutaneous defibrillator system, a different device approach.No office rate

33264 billing questions

How does this code differ from 33263?

33264 is for a multiple-lead ICD system; 33263 is for a dual-lead system. Choose based on the documented configuration of the system whose generator is being replaced.

Can the old generator removal be reported separately?

Removal of the old generator is part of the exchange described by 33264. The code covers replacing the generator while retaining the existing lead system.

Can modifier 50 be used?

No. CMS identifies bilateral adjustment as inappropriate for this code and anatomy.

Is an assistant surgeon payable for this procedure?

CMS identifies a statutory restriction on assistant-at-surgery payment. Co-surgeons and team surgery are also not permitted for this code.

What documentation supports reporting 33264?

Document the ICD system’s multiple-lead configuration, the reason for generator exchange, removal and replacement of the pulse generator, and the work performed to connect and test it.

How does the global period affect follow-up billing?

The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the standard multiple procedure reduction applies.

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 33264PPRRVU2026_Oct_nonQPP.csv, line 3,887 (RVU26D)

Open CMS sourceHow we calculate rates

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