Billing code 33264: ICD generator replacementMedicare rate & RVUs in Texas
Reports removal and replacement of an implantable defibrillator pulse generator when the existing system has multiple leads, such as a CRT-D system.
CMS doesn’t publish an office rate for 33264 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 33264 covers
An electrophysiologist or other qualified cardiac proceduralist removes the implanted defibrillator generator and connects a replacement to the existing multiple-lead system. Common indications include battery depletion or generator malfunction. The procedure is typically performed in a hospital electrophysiology lab or operating room; a system with atrial, right-ventricular, and left-ventricular leads is a familiar example. This code describes generator exchange, not implantation of a new lead system.
Select the code based on the existing system’s lead configuration: this multiple-lead code differs from the single- and dual-lead generator replacement codes. Document the device and lead configuration, reason for exchange, generator removal and replacement, and testing performed. The generator exchange includes a 90-day global period, including the day-before preoperative visit and related postoperative care. 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; assistant-at-surgery payment is restricted, 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.
Where 33264 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 | $356.03 |
| Beaumont | Unavailable | $342.94 |
| Brazoria | Unavailable | $345.41 |
| Dallas | Unavailable | $349.92 |
| Fort Worth | Unavailable | $349.56 |
| Galveston | Unavailable | $347.95 |
| Houston | Unavailable | $374.68 |
| Rest Of Texas | Unavailable | $345.56 |
How the 33264 rate is calculated
Each of 33264’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 · 33264
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.19Practice expense 2.99Malpractice 1.46
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 33264
33264 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 33264
ICD generator replacement
| 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 · 33264
ICD generator replacement
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
33264 without 51 · national facility
$355.39
ICD generator replacement
33264-51 · Second procedure: 50%
$177.70
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%).
33264 compared with similar codes
Compare codes
33264 vs 33262 vs 33263 vs 33249 vs 33270: 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; 33264 is for a multiple-lead system.
- 33263ICD generator exchange
- Use 33263 for a dual-lead ICD system. Use 33264 when the documented system has multiple leads beyond that configuration.
- 33249Defibrillator implant
- 33264 describes exchange of the pulse generator while retaining the existing leads. 33249 is for insertion or replacement of a transvenous ICD system with lead work.
- 33270Defibrillator implant
- 33270 concerns a subcutaneous defibrillator system; 33264 is for generator exchange in a multiple-lead ICD system.
33264 billing questions
How does this code differ from 33263?
33264 is for a multiple-lead ICD system; 33263 is for a dual-lead system. Choose based on the documented configuration of the system whose generator is being replaced.
Can the old generator removal be reported separately?
Removal of the old generator is part of the exchange described by 33264. The code covers replacing the generator while retaining the existing lead system.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code and anatomy.
Is an assistant surgeon payable for this procedure?
CMS identifies a statutory restriction on assistant-at-surgery payment. Co-surgeons and team surgery are also not permitted for this code.
What documentation supports reporting 33264?
Document the ICD system’s multiple-lead configuration, the reason for generator exchange, removal and replacement of the pulse generator, and the work performed to connect and test it.
How does the global period affect follow-up billing?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the standard multiple procedure reduction applies.
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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