Billing code 33223: Defibrillator pocketMedicare rate & RVUs in Nebraska
Reports surgical relocation of an existing implantable defibrillator generator pocket when the device is moved to a different pocket site.
CMS doesn’t publish an office rate for 33223 in Nebraska.
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 33223 covers
The implanting physician opens the existing pocket, frees the defibrillator generator, creates a pocket in a different location, and places the generator there. This may be done when the current pocket causes discomfort or has inadequate tissue coverage. The procedure is typically performed by a cardiac electrophysiologist or other implanting specialist in a hospital or surgical facility; the generator is moved while the existing system’s leads generally remain in place.
Report 33223 when the operative work relocates the defibrillator pocket, rather than merely repositioning a lead or replacing the generator. Document the reason for relocation, the original and new pocket sites, and the work performed on the generator and leads. The code has a 90-day global period, including the day-before preoperative visit and 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 not appropriate. Assistant-at-surgery payment requires documentation of medical necessity; 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.
33223 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | Unavailable | $325.61 |
How the 33223 rate is calculated
Each of 33223’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 · 33223
RVUs × geographic indexes × conversion factor
Work6.14
6.14 RVUs× 1.000 GPCI
Practice expense3.32
3.32 RVUs× 1.000 GPCI
Malpractice1.44
1.44 RVUs× 1.000 GPCI
Adjusted RVUs
10.9000
Conversion factor
$33.4009
Medicare rate
$364.07
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33223
33223 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33223
Defibrillator pocket
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 33223
Defibrillator pocket
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
33223 without 51 · national facility
$364.07
Defibrillator pocket
33223-51 · Second procedure: 50%
$182.04
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%).
33223 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33222Pocket relocation
- 33222 is for relocation of a pacemaker pocket; 33223 is for relocation of an implantable defibrillator pocket.
- 33215Lead repositioning
- Choose 33215 for repositioning a pacing-defibrillator lead. Choose 33223 when the generator pocket itself is moved.
- 33249Defibrillator implant
- 33249 describes implantation or replacement of a transvenous defibrillator system; 33223 describes relocation of an existing generator pocket.
33223 billing questions
How is pocket relocation different from defibrillator lead repositioning?
33223 describes moving the generator pocket to a different site. Use 33215 when the work repositions a pacing-defibrillator lead rather than relocating the pocket.
Can 33223 be reported when the generator is replaced?
The defining work is relocating the pocket, not replacing the generator. Document the pocket relocation separately from any generator replacement performed during the encounter.
What documentation supports 33223?
Document the clinical reason for changing the pocket site, its prior and new locations, and the operative steps used to move the generator. Describe any separate lead or generator work as well.
What global period applies?
33223 has a 90-day global period. The day-before preoperative visit and related postoperative care during that period are included.
When is assistant-at-surgery payment allowed?
CMS payment for an assistant at surgery requires documentation that the assistant was medically necessary. Co-surgeons and team surgery are not permitted for this code.
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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