Billing code 33243: ICD lead removalMedicare rate & RVUs in Texas
Reports surgical removal of an implantable defibrillator lead through a thoracotomy, rather than removal by transvenous extraction.
CMS doesn’t publish an office rate for 33243 in Texas.
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 33243 covers
This service removes an implantable cardioverter-defibrillator (ICD) lead through an open chest approach. It is performed in an operating room, typically by a cardiac surgeon or cardiothoracic surgeon, when the lead is removed surgically rather than extracted through the veins. The code represents lead removal; removal of the pulse generator is a separate service. The transvenous extraction approach is reported with a different code.
Select this code when the operative report documents thoracotomy access and removal of an ICD lead. Documentation should identify the device and lead removed, the surgical approach, and any separately performed generator removal. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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 multiple-procedure reduction. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted. Modifier 50 is not appropriate.
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 33243 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $1,303.33 |
| Beaumont | Unavailable | $1,258.34 |
| Brazoria | Unavailable | $1,264.75 |
| Dallas | Unavailable | $1,281.88 |
| Fort Worth | Unavailable | $1,280.83 |
| Galveston | Unavailable | $1,274.44 |
| Houston | Unavailable | $1,377.13 |
| Rest Of Texas | Unavailable | $1,267.04 |
How the 33243 rate is calculated
Each of 33243’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 · 33243
RVUs × geographic indexes × conversion factor
Work22.98
22.98 RVUs× 1.000 GPCI
Practice expense10.42
10.42 RVUs× 1.000 GPCI
Malpractice5.61
5.61 RVUs× 1.000 GPCI
Adjusted RVUs
39.0100
Conversion factor
$33.4009
Medicare rate
$1,302.97
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 33243
33243 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33243
ICD lead removal
| 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 33243
ICD lead removal
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
33243 without 51 · national facility
$1,302.97
ICD lead removal
33243-51 · Second procedure: 50%
$651.49
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%).
33243 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 33244ICD lead extraction
- Both concern ICD lead removal, but 33243 uses a thoracotomy approach and 33244 uses transvenous extraction.
- 33241ICD generator removal
- 33241 reports removal of the ICD pulse generator; 33243 reports removal of an ICD lead through thoracotomy.
- 33236Lead removal
- 33236 is for pacemaker electrode removal through thoracotomy. Use 33243 for an ICD lead removed by that approach.
33243 billing questions
When should 33243 be used instead of 33244?
Use 33243 for removal of an ICD lead through thoracotomy. Use 33244 when the lead is removed by transvenous extraction.
Does 33243 include removal of the ICD generator?
No. This code represents lead removal; report generator removal separately when performed, using 33241.
Can 33241 be reported with 33243?
It may be reported when the ICD pulse generator is also removed during the encounter. The operative documentation should support both the generator removal and thoracotomy lead removal.
What documentation supports 33243?
Document the ICD lead removed and the thoracotomy approach. The operative report should distinguish this surgical removal from transvenous extraction.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Is modifier 50 appropriate?
No. Modifier 50 is not appropriate for this lead-removal service.
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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