Billing code 33230: ICD generatorMedicare rate & RVUs in Guam
Reports insertion of an implantable defibrillator pulse generator when two compatible leads are already in place and the leads are connected to the new generator.
CMS doesn’t publish an office rate for 33230 in Guam.
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 9 sections
What 33230 covers
An electrophysiologist or other qualified cardiac device physician places an implantable cardioverter-defibrillator (ICD) pulse generator and connects it to two leads already in the patient. The procedure is performed in a hospital or other facility equipped for cardiac device implantation. It covers the generator work, not placement of new leads or implantation of an entire new transvenous ICD system.
Select this code when the documented service is generator insertion for an existing dual-lead system. The operative report should establish that two leads were present and connected to the new generator; a procedure that adds leads or implants the complete system is a different service. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during the 90 days. 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. Medicare does not pay an assistant at surgery for this procedure, 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.
33230 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $325.26 |
How the 33230 rate is calculated
Each of 33230’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 · 33230
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.92Practice expense 2.64Malpractice 1.41
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 33230
33230 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33230
ICD generator
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 33230
ICD 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
33230 without 51 · national facility
$333.01
ICD generator
33230-51 · Second procedure: 50%
$166.51
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%).
33230 compared with similar codes
Compare codes
33230 vs 33231 vs 33240 vs 33249: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 33231Defibrillator generator
- Choose 33230 when the existing system has two leads; choose 33231 when it has multiple leads.
- 33240Defibrillator generator
- 33240 applies to a single-lead defibrillator system. Code 33230 is for two existing leads.
- 33249Defibrillator implant
- 33230 covers generator insertion with existing leads; 33249 covers implantation or replacement of the complete transvenous ICD system.
33230 billing questions
When is 33230 chosen instead of 33231?
Use 33230 for generator insertion with two existing leads. Code 33231 is for an existing system with multiple leads.
Does 33230 include placement of new leads?
No. It covers placement of the generator and connection to two existing leads. Report a different service when new leads are inserted.
How does 33230 differ from 33249?
33230 is generator-only work with existing dual leads. Code 33249 describes implantation or replacement of the complete transvenous ICD system.
What documentation supports the dual-lead selection?
The operative report should identify the generator insertion and establish that two existing leads were connected to it.
Can modifier 50 be appended for bilateral work?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this device procedure.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures 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
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