Summary & Overview
CPT 0574T: Reposition Substernal Implantable Defibrillator–Pacing Electrode
CPT code 0574T covers surgical repositioning of a previously implanted substernal implantable defibrillator–pacing electrode and reattachment to a pulse generator. The procedure is clinically important where subcutaneous or transvenous electrode approaches are not feasible, offering an alternative pathway for defibrillation and pacing in select patients. Nationally, this code reflects specialized cardiac device management and has implications for hospital procedural coding, device-related quality measurement, and reimbursement for advanced electrophysiology services.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise overview of the clinical scenario the code represents, typical settings where the service is performed, and which major payers commonly cover these services. The publication provides benchmarks and coding context, policy and coverage notes relevant to payers, and clinical background on when substernal electrodes may be used versus subcutaneous or transvenous systems.
This summary is intended for coding managers, cardiology practice leaders, revenue cycle professionals, and policy analysts seeking a national-level briefing on the role of CPT code 0574T in contemporary electrophysiology care and payer coverage considerations.
Billing Code Overview
CPT code 0574T describes the repositioning of a previously placed substernal implantable defibrillator–pacing electrode and its attachment to a pulse generator. This procedure is performed when a substernal electrode, implanted beneath the sternum, requires surgical repositioning and reconnection to the device that senses and regulates the heart rhythm.
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Service type: Surgical repositioning of an implantable defibrillator–pacing electrode
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Typical site of service: Hospital operating room or specialized cardiac electrophysiology procedural suite
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Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with ischemic cardiomyopathy and recurrent ventricular tachycardia presents after prior attempts at subcutaneous and transvenous lead placement were deemed infeasible due to limited vascular access and infection risk. The electrophysiology team schedules the patient for a procedure to reposition a previously placed substernal implantable defibrillator–pacing electrode and attach it to a pulse generator. Typical workflow includes preoperative device interrogation and imaging review, informed consent discussing risks of bleeding, infection, lead displacement, and device malfunction, perioperative antibiotic prophylaxis, procedural anesthesia (general or monitored anesthesia care), surgical exposure of the substernal pocket and generator site, careful dissection to locate the previously tunneled substernal electrode, lead assessment and repositioning as needed, secure attachment to the pulse generator, intraoperative device testing including sensing and defibrillation threshold testing as indicated, wound closure, and postoperative device programming and chest radiograph to document lead position. Typical site of service is an operating room or cardiac electrophysiology procedure suite in an acute care hospital. Typical patient scenario: symptomatic ventricular arrhythmia or device malfunction in a patient with limited venous access, prior device infection, or anatomical considerations making substernal electrode the optimal approach.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced services | Use when the procedure is partially reduced or not completed as originally planned. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons. |
66 | Surgical team | Use when multiple surgeons participate in a surgical team providing care. |
78 | Unplanned return to OR for related procedure during the postoperative period | Use when the patient returns to the OR for a related procedure on the same site during the global period. |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period. (Not in provided list; excluded.) |
80 | Assistant surgeon | Use when an assistant surgeon is required for the procedure. |
81 | Minimum assistant surgeon | Use when a minimum assistant is documented and required. |
82 | Assistant surgeon (when eligible assistant not available) | Use when assistant surgeon is needed but a qualified resident is not available. |
78 | (duplicate) See above | (duplicate entry omitted in practice) |
22 | Unusual procedural services | Use when work required to complete the procedure is substantially greater than typically required. |
23 | Unusual anesthesia | Use when general anesthesia is medically necessary but not planned with the procedure's usual anesthesia. |
62 | (duplicate) See above | (duplicate entry omitted in practice) |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for surgical procedures | Use when an APP performs or assists and billing requires modifier to indicate non-physician practitioner. |
QX | Modifier indicating CRNA services with physician direction (modifier pair with QK) | Use when a CRNA provides anesthesia services with required physician direction. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RP0000X | Cardiac Electrophysiology | Electrophysiologists perform device implant and lead management procedures. |
| 207RH0000X | Cardiology | Interventional cardiologists or cardiac electrophysiologists involved in device procedures. |
| 208000000X | Thoracic Surgery | Thoracic surgeons may participate when substernal access or reoperation is complex. |
| 363L00000X | Anesthesiology | Anesthesiologists provide general or monitored anesthesia care. |
| 363A00000X | Certified Registered Nurse Anesthetist | CRNAs commonly provide anesthesia support in operative settings. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I49.01 | Ventricular fibrillation | Indicates life-threatening ventricular arrhythmia that may necessitate an implantable defibrillator and lead repositioning. |
I46.9 | Cardiac arrest, cause unspecified | Cardiac arrest survivors are common candidates for ICD therapy and may require lead management. |
I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | Underlying ischemic cardiomyopathy often coexists with ventricular arrhythmias prompting ICD therapy. |
I50.22 | Chronic systolic (congestive) heart failure | Systolic heart failure with reduced ejection fraction is an indication for ICD placement for primary prevention. |
T82.8XXA | Other complication of cardiac electronic device, initial encounter | Used when device malfunction or lead-related complication prompts repositioning or reattachment. |
Z45.01 | Encounter for adjustment and management of cardiac pacemaker | Used for postoperative management and device reprogramming encounters related to ICD systems. |
T82.89XA | Other specified complication of other cardiac and vascular devices and implants, initial encounter | Used for complications requiring procedural correction such as lead malposition. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
33207 | Insertion or replacement of permanent pacemaker with transvenous electrode(s); single lead, with subcutaneous pocket | May be performed when transvenous pacing is feasible or in initial device implantation workflows. |
33208 | Insertion or replacement of permanent pacemaker with transvenous electrode(s); two leads | Related when pacing needs require additional lead configuration versus substernal approach. |
33249 | Insertion or replacement of implantable cardioverter-defibrillator, single lead, transvenous | Alternative device implantation technique if transvenous lead placement is possible. |
33262 | Insertion or replacement of implantable cardioverter-defibrillator (ICD), epicardial or subcutaneous lead system, with pulse generator | Related for subcutaneous or epicardial systems; part of differential approach to lead placement. |
0570T | Substernal implantable defibrillator–pacing electrode placement, initial placement | Commonly performed before 0574T when the electrode is initially placed; 0574T describes repositioning of a previously placed substernal electrode. |
33235 | Revision or removal of transvenous pacemaker or ICD lead(s) | Performed when lead extraction, revision, or replacement is required in the device management workflow. |