Summary & Overview

CPT 0580T: Removal of Substernal Implantable Defibrillator Pulse Generator

CPT code 0580T identifies the surgical removal of a substernal implantable defibrillator pulse generator by reopening the surgically created chest wall pocket. This code captures a targeted explantation procedure addressing implanted devices that sense cardiac rhythm and deliver shocks to treat life‑threatening arrhythmias. The code is nationally relevant as explantation of implantable cardioverter‑defibrillators occurs across hospital and ambulatory surgical settings and has implications for device management, perioperative planning, and payment processing.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the procedure, typical sites of service, and the operational significance of reporting a distinct code for substernal ICD pulse generator removal. The publication covers benchmark elements such as common billing practices and service line placement, policy considerations affecting coverage and site‑of‑service utilization, and coding guidance to support accurate claim submission. Data not available in the input is noted where applicable, and readers will gain a concise reference to support clinical, billing, and administrative stakeholders handling explantation of substernal defibrillator pulse generators.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0580TCPTimplantable cardioverter-defibrillatordevice explantationcardiac surgeryambulatory surgeryhospital inpatientsurgical billing

Billing Code Overview

CPT code 0580T describes the surgical removal of a substernal implantable cardioverter-defibrillator (ICD) pulse generator through the previously created chest wall pocket. The procedure involves reopening the surgically created pocket in the chest wall to extract the substernal pulse generator that senses cardiac rhythm and delivers therapeutic shocks when indicated.

Service type: Surgical device explantation of an implantable defibrillator pulse generator
Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgical center, depending on clinical status and facility capabilities

Clinical & Coding Specifications

Clinical Context

A patient with an implanted substernal implantable cardioverter-defibrillator (ICD) pulse generator presents for removal of the pulse generator due to device malfunction and battery depletion. The patient is a 68-year-old male with ischemic cardiomyopathy, prior ICD implantation placed in a surgically created substernal pocket because of limited subcutaneous tissue. The procedure is performed in an operating room setting under general anesthesia with cardiac monitoring and fluoroscopic support available. The surgical team opens the previously created substernal pocket in the chest wall, isolates the pulse generator, disconnects and caps leads as indicated, and removes the generator. Intraoperative device interrogation is performed before and after removal to document device status. Typical perioperative workflow includes preoperative device and medical history review, informed consent, anesthesia induction, sterile pocket exposure, hemostasis, wound closure, and immediate postoperative monitoring in a recovery area with telemetry prior to discharge or transfer to a higher level of care. Common reasons for removal include battery end-of-life, device infection, generator malfunction, or planned system revision/replacement.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to remove the substernal generator is substantially greater than usual, with documented justification.
`23`	Unusual anesthesia	Use when general anesthesia is required for a procedure that normally uses local anesthesia and documentation supports the need.
`51`	Multiple procedures	Use when the generator removal is reported with additional unrelated procedures during the same operative session.
`52`	Reduced services	Use when a partially reduced service is performed and documentation supports reduced effort.
`53`	Discontinued procedure	Use when the procedure is started but halted for patient safety reasons prior to completion.
`54`	Surgical care only	Use when only the surgical portion of care is billed and other providers bill pre/postoperative care separately.
`55`	Postop management only	Use when only postoperative management is billed by a provider who did not perform the surgery.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons for the removal.
`78`	Unplanned return to OR following initial procedure	Use when the patient returns to the operating room for a related procedure during the global period.
`80`	Assistant surgeon	Use when a qualified assistant surgeon performs part of the operative procedure.
`81`	Minimum assistant surgeon	Use when a minimal assistant role is documented.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist service	Use when an assistant from these professions provides surgical assistance if supported by payer rules.
`QK`	Medical direction of two, three, or four CRNAs	Use when the physician medically directs multiple CRNAs during anesthesia for the procedure.
`QX`	CRNA service with medical direction	Use when a CRNA furnishes anesthesia services under the medical direction of a physician during the case.

Taxonomy Code	Specialty	Notes
208000000X	Cardiac Surgery	Surgeons who perform device explantation and chest wall pocket work.
207RC0000X	Electrophysiology Cardiology	Cardiac electrophysiologists who manage ICD systems and perform generator procedures.
207L00000X	Cardiovascular Disease	Cardiologists involved in perioperative management and device planning.
2086S0122X	Thoracic Surgery	Thoracic surgeons when substernal pocket access requires chest wall or mediastinal expertise.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I42.0`	Dilated cardiomyopathy	Indication for ICD therapy for prevention of sudden cardiac death; patients may present for generator replacement or removal.
`I50.22`	Chronic systolic (congestive) heart failure	Common underlying cardiomyopathy leading to ICD placement for primary or secondary prevention.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina	Ischemic heart disease is a frequent cause of reduced ejection fraction and ICD implantation.
`Z45.010`	Encounter for adjustment and management of automatic implantable cardiac defibrillator	Used for device management encounters and may appear in the chart for generator procedures.
`T82.7XXA`	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter	Device infection is a common reason for complete or partial generator removal.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33207`	Removal of pacemaker or ICD pulse generator only; single lead system	Performed when only the generator is removed for simpler systems—related alternative for subcutaneous pockets.
`33208`	Removal of pacemaker or ICD pulse generator only; two leads	Alternative/code for generator removal in transvenous systems with multiple leads; may be part of staged lead management.
`33233`	Insertion or replacement of ICD pulse generator; single or dual chamber, with existing leads	Performed after generator removal when a new generator is implanted in the same or new pocket during the same or subsequent procedure.
`33234`	Insertion or replacement of ICD pulse generator with subcutaneous array only	Relevant when system configuration differs and reimplantation involves subcutaneous components.
`33216`	Removal of epicardial lead(s); without replacement	Performed when lead removal is required in addition to generator explantation; may be part of complex extraction workflow.

Beta

OpenPayer Beta

Summary & Overview

CPT 0580T: Removal of Substernal Implantable Defibrillator Pulse Generator

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0580TCPTimplantable cardioverter-defibrillatordevice explantationcardiac surgeryambulatory surgeryhospital inpatientsurgical billing

Billing Code Overview

Service type: Surgical device explantation of an implantable defibrillator pulse generator
Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgical center, depending on clinical status and facility capabilities

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to remove the substernal generator is substantially greater than usual, with documented justification.
`23`	Unusual anesthesia	Use when general anesthesia is required for a procedure that normally uses local anesthesia and documentation supports the need.
`51`	Multiple procedures	Use when the generator removal is reported with additional unrelated procedures during the same operative session.
`52`	Reduced services	Use when a partially reduced service is performed and documentation supports reduced effort.
`53`	Discontinued procedure	Use when the procedure is started but halted for patient safety reasons prior to completion.
`54`	Surgical care only	Use when only the surgical portion of care is billed and other providers bill pre/postoperative care separately.
`55`	Postop management only	Use when only postoperative management is billed by a provider who did not perform the surgery.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons for the removal.
`78`	Unplanned return to OR following initial procedure	Use when the patient returns to the operating room for a related procedure during the global period.
`80`	Assistant surgeon	Use when a qualified assistant surgeon performs part of the operative procedure.
`81`	Minimum assistant surgeon	Use when a minimal assistant role is documented.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist service	Use when an assistant from these professions provides surgical assistance if supported by payer rules.
`QK`	Medical direction of two, three, or four CRNAs	Use when the physician medically directs multiple CRNAs during anesthesia for the procedure.
`QX`	CRNA service with medical direction	Use when a CRNA furnishes anesthesia services under the medical direction of a physician during the case.

Taxonomy Code	Specialty	Notes
208000000X	Cardiac Surgery	Surgeons who perform device explantation and chest wall pocket work.
207RC0000X	Electrophysiology Cardiology	Cardiac electrophysiologists who manage ICD systems and perform generator procedures.
207L00000X	Cardiovascular Disease	Cardiologists involved in perioperative management and device planning.
2086S0122X	Thoracic Surgery	Thoracic surgeons when substernal pocket access requires chest wall or mediastinal expertise.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I42.0`	Dilated cardiomyopathy	Indication for ICD therapy for prevention of sudden cardiac death; patients may present for generator replacement or removal.
`I50.22`	Chronic systolic (congestive) heart failure	Common underlying cardiomyopathy leading to ICD placement for primary or secondary prevention.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina	Ischemic heart disease is a frequent cause of reduced ejection fraction and ICD implantation.
`Z45.010`	Encounter for adjustment and management of automatic implantable cardiac defibrillator	Used for device management encounters and may appear in the chart for generator procedures.
`T82.7XXA`	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter	Device infection is a common reason for complete or partial generator removal.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33207`	Removal of pacemaker or ICD pulse generator only; single lead system	Performed when only the generator is removed for simpler systems—related alternative for subcutaneous pockets.
`33208`	Removal of pacemaker or ICD pulse generator only; two leads	Alternative/code for generator removal in transvenous systems with multiple leads; may be part of staged lead management.
`33233`	Insertion or replacement of ICD pulse generator; single or dual chamber, with existing leads	Performed after generator removal when a new generator is implanted in the same or new pocket during the same or subsequent procedure.
`33234`	Insertion or replacement of ICD pulse generator with subcutaneous array only	Relevant when system configuration differs and reimplantation involves subcutaneous components.
`33216`	Removal of epicardial lead(s); without replacement	Performed when lead removal is required in addition to generator explantation; may be part of complex extraction workflow.