Billing code 33263: ICD generator exchangeMedicare rate & RVUs in Nebraska
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 doesn’t publish an office rate for 33263 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 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.
33263 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | Unavailable | $305.76 |
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
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
| 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 · 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.
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%).
33263 compared with similar codes
Compare codes
33263 vs 33262 vs 33264 vs 33249: national Medicare rates
Swap in your local Medicare rate.
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.
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
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