No office rate
33249 includes transvenous lead placement as part of the ICD system procedure. Use 33240 for the applicable generator-only service without lead placement.
On this page
CMS RVU26D · Effective 2026-10-01
33249 in Madera
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$772.00
Base rate per service
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.
Cardiac device surgery
About 33249: Transvenous implantable defibrillator system placement
Reports implantation or replacement of a complete transvenous implantable defibrillator system when the procedure includes placement of one or more leads.
An electrophysiologist or cardiac surgeon places an implantable cardioverter-defibrillator (ICD) generator and transvenous lead or leads, commonly in a hospital electrophysiology lab. The leads pass through a vein into the heart, where the system can detect and treat dangerous ventricular rhythms with electrical therapy. Typical indications include prevention of sudden cardiac death in patients at risk of life-threatening ventricular arrhythmias, or treatment after a qualifying arrhythmic event.
Choose this code when the procedure involves the complete transvenous ICD system, including lead placement, rather than a generator-only service. The operative report should identify the indication, implanted generator, lead placement, and whether the procedure was an insertion or replacement. Medicare assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery services are not paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 33249
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.55 · 61%
- Practice expense (office) RVU5.91 · 25%
- Malpractice RVU3.43 · 14%
28.8K
Medicare services in 2024 · #987 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.
33249 compared with similar codes
Office rates for Madera, from the same CMS release.
No office rate
33263 reports removal and replacement of a generator in a dual-lead ICD system when the leads are retained; 33249 includes transvenous lead placement.
No office rate
33264 reports removal and replacement of a generator in a multiple-lead ICD system when the leads are retained; 33249 includes transvenous lead placement.
The same code, a different location
How does Madera compare?
33249 across payment areas
Same release and payment basis · bars start at $0
Madera · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Merced
California · 33249
Office
Unavailable
Facility
$772.00
No comparable office rate is available.
Modesto
California · 33249
Office
Unavailable
Facility
$772.00
No comparable office rate is available.
Napa
California · 33249
Office
Unavailable
Facility
$834.97
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 33249
Office
Unavailable
Facility
$804.29
No comparable office rate is available.
Redding
California · 33249
Office
Unavailable
Facility
$772.00
No comparable office rate is available.
Rest Of California
California · 33249
Office
Unavailable
Facility
$772.00
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 33249
Office
Unavailable
Facility
$808.80
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 33249
Office
Unavailable
Facility
$794.46
No comparable office rate is available.
Salinas
California · 33249
Office
Unavailable
Facility
$791.24
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 33249
Office
Unavailable
Facility
$798.75
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 33249
Office
Unavailable
Facility
$863.07
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 33249
Office
Unavailable
Facility
$859.17
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 33249
Office
Unavailable
Facility
$885.50
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 33249
Office
Unavailable
Facility
$869.57
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 33249
Office
Unavailable
Facility
$780.49
No comparable office rate is available.
Santa Cruz-Watsonville
California · 33249
Office
Unavailable
Facility
$797.44
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 33249
Office
Unavailable
Facility
$791.17
No comparable office rate is available.
Santa Rosa-Petaluma
California · 33249
Office
Unavailable
Facility
$804.38
No comparable office rate is available.
Stockton
California · 33249
Office
Unavailable
Facility
$772.00
No comparable office rate is available.
Vallejo
California · 33249
Office
Unavailable
Facility
$829.36
No comparable office rate is available.
Visalia
California · 33249
Office
Unavailable
Facility
$772.00
No comparable office rate is available.
Yuba City
California · 33249
Office
Unavailable
Facility
$772.00
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 33249
Office
Unavailable
Facility
$872.27
No comparable office rate is available.
Miami
Florida · 33249
Office
Unavailable
Facility
$981.21
No comparable office rate is available.
Chicago
Illinois · 33249
Office
Unavailable
Facility
$950.70
No comparable office rate is available.
Manhattan
New York · 33249
Office
Unavailable
Facility
$928.16
No comparable office rate is available.
Alaska*
Alaska · 33249
Office
Unavailable
Facility
$1002.33
No comparable office rate is available.
Alabama
Alabama · 33249
Office
Unavailable
Facility
$723.55
No comparable office rate is available.
Arkansas
Arkansas · 33249
Office
Unavailable
Facility
$714.55
No comparable office rate is available.
Arizona
Arizona · 33249
Office
Unavailable
Facility
$775.33
No comparable office rate is available.
Colorado
Colorado · 33249
Office
Unavailable
Facility
$791.32
No comparable office rate is available.
Connecticut
Connecticut · 33249
Office
Unavailable
Facility
$846.93
No comparable office rate is available.
Delaware
Delaware · 33249
Office
Unavailable
Facility
$786.44
No comparable office rate is available.
Fort Lauderdale
Florida · 33249
Office
Unavailable
Facility
$893.08
No comparable office rate is available.
Rest Of Florida
Florida · 33249
Office
Unavailable
Facility
$846.89
No comparable office rate is available.
Atlanta
Georgia · 33249
Office
Unavailable
Facility
$825.59
No comparable office rate is available.
Rest Of Georgia
Georgia · 33249
Office
Unavailable
Facility
$798.62
No comparable office rate is available.
Hawaii, Guam
Hawaii · 33249
Office
Unavailable
Facility
$776.76
No comparable office rate is available.
Iowa
Iowa · 33249
Office
Unavailable
Facility
$712.09
No comparable office rate is available.
Idaho
Idaho · 33249
Office
Unavailable
Facility
$721.78
No comparable office rate is available.
East St. Louis
Illinois · 33249
Office
Unavailable
Facility
$898.32
No comparable office rate is available.
Rest Of Illinois
Illinois · 33249
Office
Unavailable
Facility
$845.27
No comparable office rate is available.
Suburban Chicago
Illinois · 33249
Office
Unavailable
Facility
$895.12
No comparable office rate is available.
Indiana
Indiana · 33249
Office
Unavailable
Facility
$724.65
No comparable office rate is available.
Kansas
Kansas · 33249
Office
Unavailable
Facility
$722.17
No comparable office rate is available.
Kentucky
Kentucky · 33249
Office
Unavailable
Facility
$766.30
No comparable office rate is available.
New Orleans
Louisiana · 33249
Office
Unavailable
Facility
$801.88
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 33249
Office
Unavailable
Facility
$770.43
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 33249
Office
Unavailable
Facility
$843.57
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 33249
Office
Unavailable
Facility
$792.93
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 33249
Office
Unavailable
Facility
$847.29
No comparable office rate is available.
Rest Of Maryland
Maryland · 33249
Office
Unavailable
Facility
$795.78
No comparable office rate is available.
Rest Of Maine
Maine · 33249
Office
Unavailable
Facility
$738.85
No comparable office rate is available.
Southern Maine
Maine · 33249
Office
Unavailable
Facility
$753.90
No comparable office rate is available.
Detroit
Michigan · 33249
Office
Unavailable
Facility
$869.63
No comparable office rate is available.
Rest Of Michigan
Michigan · 33249
Office
Unavailable
Facility
$795.55
No comparable office rate is available.
Minnesota
Minnesota · 33249
Office
Unavailable
Facility
$723.02
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 33249
Office
Unavailable
Facility
$783.27
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 33249
Office
Unavailable
Facility
$788.70
No comparable office rate is available.
Rest Of Missouri
Missouri · 33249
Office
Unavailable
Facility
$767.73
No comparable office rate is available.
Mississippi
Mississippi · 33249
Office
Unavailable
Facility
$740.61
No comparable office rate is available.
Montana**
Montana · 33249
Office
Unavailable
Facility
$797.72
No comparable office rate is available.
North Carolina
North Carolina · 33249
Office
Unavailable
Facility
$743.36
No comparable office rate is available.
North Dakota**
North Dakota · 33249
Office
Unavailable
Facility
$729.90
No comparable office rate is available.
Nebraska
Nebraska · 33249
Office
Unavailable
Facility
$711.49
No comparable office rate is available.
New Hampshire
New Hampshire · 33249
Office
Unavailable
Facility
$791.72
No comparable office rate is available.
Northern Nj
New Jersey · 33249
Office
Unavailable
Facility
$867.94
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 33249
Office
Unavailable
Facility
$846.66
No comparable office rate is available.
New Mexico
New Mexico · 33249
Office
Unavailable
Facility
$804.59
No comparable office rate is available.
Nevada**
Nevada · 33249
Office
Unavailable
Facility
$779.01
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 33249
Office
Unavailable
Facility
$964.54
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 33249
Office
Unavailable
Facility
$862.63
No comparable office rate is available.
Queens
New York · 33249
Office
Unavailable
Facility
$915.61
No comparable office rate is available.
Rest Of New York
New York · 33249
Office
Unavailable
Facility
$754.05
No comparable office rate is available.
Ohio
Ohio · 33249
Office
Unavailable
Facility
$781.69
No comparable office rate is available.
Oklahoma
Oklahoma · 33249
Office
Unavailable
Facility
$751.28
No comparable office rate is available.
Portland
Oregon · 33249
Office
Unavailable
Facility
$798.31
No comparable office rate is available.
Rest Of Oregon
Oregon · 33249
Office
Unavailable
Facility
$763.13
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 33249
Office
Unavailable
Facility
$836.90
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 33249
Office
Unavailable
Facility
$775.46
No comparable office rate is available.
Puerto Rico
Puerto Rico · 33249
Office
Unavailable
Facility
$798.40
No comparable office rate is available.
Rhode Island
Rhode Island · 33249
Office
Unavailable
Facility
$801.32
No comparable office rate is available.
South Carolina
South Carolina · 33249
Office
Unavailable
Facility
$765.76
No comparable office rate is available.
South Dakota**
South Dakota · 33249
Office
Unavailable
Facility
$721.88
No comparable office rate is available.
Tennessee
Tennessee · 33249
Office
Unavailable
Facility
$726.94
No comparable office rate is available.
Austin
Texas · 33249
Office
Unavailable
Facility
$797.31
No comparable office rate is available.
Beaumont
Texas · 33249
Office
Unavailable
Facility
$772.05
No comparable office rate is available.
Brazoria
Texas · 33249
Office
Unavailable
Facility
$774.85
No comparable office rate is available.
Dallas
Texas · 33249
Office
Unavailable
Facility
$785.26
No comparable office rate is available.
Fort Worth
Texas · 33249
Office
Unavailable
Facility
$784.78
No comparable office rate is available.
Galveston
Texas · 33249
Office
Unavailable
Facility
$780.75
No comparable office rate is available.
Houston
Texas · 33249
Office
Unavailable
Facility
$843.53
No comparable office rate is available.
Rest Of Texas
Texas · 33249
Office
Unavailable
Facility
$776.77
No comparable office rate is available.
Utah
Utah · 33249
Office
Unavailable
Facility
$774.42
No comparable office rate is available.
Virginia
Virginia · 33249
Office
Unavailable
Facility
$760.91
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 33249
Office
Unavailable
Facility
$798.40
No comparable office rate is available.
Vermont
Vermont · 33249
Office
Unavailable
Facility
$739.38
No comparable office rate is available.
Rest Of Washington
Washington · 33249
Office
Unavailable
Facility
$787.35
No comparable office rate is available.
Seattle (King Cnty)
Washington · 33249
Office
Unavailable
Facility
$846.09
No comparable office rate is available.
Wisconsin
Wisconsin · 33249
Office
Unavailable
Facility
$710.38
No comparable office rate is available.
West Virginia
West Virginia · 33249
Office
Unavailable
Facility
$821.47
No comparable office rate is available.
Wyoming**
Wyoming · 33249
Office
Unavailable
Facility
$768.16
No comparable office rate is available.
See how rates vary across the country
33249 · 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 |
Where does this rate apply?
Madera is a Medicare payment area. Our Census mapping connects it to 17 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 33249 in Madera. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$849.20
$772.00 × 110% = $849.20
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 33249 in Madera.
PPRRVU2026_Oct_nonQPP.csv
3,873
- Code
- 33249
- Physician work
- 14.55
- Practice expense
- 5.91
- Malpractice
- 3.43
GPCI2026.csv
14
- Locality
- Madera
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.55 | × 1.017 | 14.7973 |
| Practice expense | 5.91 | × 1.096 | 6.4774 |
| Malpractice | 3.43 | × 0.536 | 1.8385 |
| Total RVUs | 23.1132 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Madera$772.00
Open 33249 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.55 | 1.017 |
| Practice expense | 5.91 | 1.096 |
| Malpractice | 3.43 | 0.536 |
(14.55 × 1.017 + 5.91 × 1.096 + 3.43 × 0.536) × $33.4009 = $772.00
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
33249 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $772.00 | RVU26D |
| 2026-07-01 | Not available in this setting | $772.00 | RVU26C |
| 2026-04-01 | Not available in this setting | $772.00 | RVU26B |
| 2026-01-01 | Not available in this setting | $772.00 | RVU26A |
| 2025-10-01 | Not available in this setting | $855.69 | RVU25D |
| 2025-07-01 | Not available in this setting | $855.69 | RVU25C |
| 2025-04-01 | Not available in this setting | $855.69 | RVU25B |
| 2025-01-01 | Not available in this setting | $855.69 | RVU25A |
33249 billing questions
When should this code be used instead of a generator-only code?
Use 33249 when the procedure includes placement of transvenous lead(s) as part of the ICD system. A generator-only procedure without lead placement is represented by a different code.
Does this code cover a single- or dual-chamber system?
It covers a transvenous ICD system with one or more leads, including single- or dual-chamber configurations. Document the leads placed and the implanted system.
What documentation supports reporting 33249?
The operative report should establish the ICD indication and describe the generator and transvenous lead placement, including whether the system was newly implanted or replaced.
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.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Assistant-at-surgery services are not paid; co-surgeons require supporting documentation.
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.
3,87033241,,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
3,87533250,,Ablate heart dysrhythm focus,A,,25.25,10.37,NA,10.37,,6.05,41.67,41.67,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,87633251,,Ablate heart dysrhythm focus,A,,28.20,10.60,NA,10.60,,7.10,45.90,45.90,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1101112,CA,56,FRESNO,1.017,1.096,0.536
1201112,CA,57,HANFORD-CORCORAN,1.017,1.096,0.536
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508