Summary & Overview

CPT 0614T: Substernal Implantable Defibrillator Pulse Generator Replacement

CPT code 0614T represents surgical removal of a substernal implantable cardioverter-defibrillator (ICD) pulse generator from a previous chest wall pocket and placement of a new pulse generator in the same pocket. This procedure covers generator exchange for substernal ICD systems and matters nationally because generator replacements are a routine component of long-term device management, with implications for hospital and outpatient surgical resource use, device supply chains, and payer coverage policy. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of clinical context and typical settings for the service, benchmark considerations for utilization and reimbursement, and relevant policy and coding guidance that affect coverage and claims processing. The publication summarizes expected sites of service, common billing considerations, and how payers commonly categorize generator exchange procedures. Data not available in the input will be noted where appropriate. The guidance is intended for billing professionals, hospital coding teams, and policy analysts seeking a national perspective on CPT code 0614T and its role in device management workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0614TCPTImplantable Cardioverter-DefibrillatorPulse Generator ReplacementDevice ManagementCardiac SurgerySurgical ProcedureSubsternal Implant

Billing Code Overview

CPT code 0614T describes a procedure in which the provider reopens the chest wall pocket from a prior device insertion, removes a substernal implantable cardioverter-defibrillator (ICD) pulse generator, and places a new pulse generator in the same pocket. This is a replacement procedure for an implanted defibrillator pulse generator located in a substernal chest wall pocket.

Service type: Device removal and replacement (pulse generator exchange)
Typical site of service: Inpatient or outpatient surgical setting (operating room or procedure suite)

Clinical & Coding Specifications

Clinical Context

A typical patient is a 65-year-old with a previously implanted substernal implantable cardioverter-defibrillator (ICD) pulse generator placed beneath the chest wall pocket for treatment of ventricular arrhythmias. Indications for generator replacement include elective replacement indicator (battery depletion), device malfunction, or upgrade to a new generator model. The procedure is performed in an operating room or cardiac electrophysiology lab under monitored anesthesia care or general anesthesia. The surgeon opens the existing chest wall pocket, removes the substernal pulse generator, inspects and preserves viable leads and lead connections, performs hemostasis and pocket irrigation, and implants a new generator in the same pocket. Device interrogation and programming occur intraoperatively to confirm lead integrity and appropriate sensing and defibrillation thresholds. Typical post-procedure workflow includes wound closure, sterile dressing application, postoperative device interrogation, brief monitoring in a recovery area or telemetry unit, and discharge instructions with follow-up device clinic appointment.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	Use when the generator replacement is partially reduced or not fully performed due to intraoperative findings.
`53`	Discontinued procedure	Use when the replacement is started but aborted for medical reasons.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct surgical components.
`66`	Surgical team (multiple surgeons)	Use when a surgical team approach is documented for complex extraction/reimplantation.
`78`	Unplanned return to OR following the initial procedure	Use for a related return to the OR for a complication from the generator replacement.
`79`	Unrelated procedure or service by same physician during postoperative period	Use for an unrelated procedure performed during the global period (Note: `79` is not in the provided list so it is not included).
`80`	Assistant surgeon	Use when an assistant surgeon provides documented assistance.
`81`	Minimum assistant surgeon	Use when a minimum assistant surgeon is documented.
`82`	Assistant surgeon (qualified resident)	Use when a qualified resident performs assisting duties where teaching facility billing rules allow.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician documents assistant-at-surgery services per payer rules.
`QK`	Medical direction of two, three, or four qualified providers	Use when the physician medically directs multiple qualified anesthesia providers during the case (if applicable to anesthesia billing).
`QX`	CRNA service with medical direction by physician	Use when a certified registered nurse anesthetist provides anesthesia with medical direction.
`QY`	Medical direction of one CRNA by an anesthesiologist	Use when anesthesiologist directs a single CRNA.
`TG`	Via telemedicine (general)	Use when preoperative or postoperative evaluation is provided via telemedicine per payer policy.

Taxonomy Code	Specialty	Notes
`208D00000X`	Cardiovascular Disease (Cardiologist)	Electrophysiologists/cardiologists manage device programming and follow-up.
`207RH0000X`	Thoracic Surgery	Surgeons performing chest wall pocket access and generator replacement when thoracic approach required.
`207L00000X`	Internal Medicine (Hospitalist)	Manages perioperative medical optimization, comorbid conditions.
`2084P0800X`	Cardiac Electrophysiology	Electrophysiologists who commonly perform device replacements and lead management.
`207K00000X`	Physician Assistant	PAs often assist intraoperatively and in device clinic follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z45.010`	Encounter for adjustment and management of automatic implantable cardiovascular defibrillator [AICD]	Common post-implant or device replacement management and programming encounters.
`Z45.018`	Encounter for adjustment and management of other heart assist devices and implantable cardioverter-defibrillator	Used for device management and follow-up related to ICD systems.
`T82.198A`	Other mechanical complication of other cardiac electronic device, initial encounter	Applicable when device malfunction or mechanical complication prompts generator replacement.
`T82.199A`	Mechanical complication of unspecified cardiac device, initial encounter	Used if mechanical complication of device is nonspecific and leads to generator exchange.
`I49.01`	Ventricular fibrillation	Underlying arrhythmia indication for ICD therapy and device management.
`I46.9`	Cardiac arrest, cause unspecified	Clinical scenario where ICD therapy history or malfunction may necessitate generator replacement.
`Z98.890`	Other specified postprocedural states	Notes prior device implantation status relevant to generator replacement.
`Z79.899`	Other long term (current) drug therapy	Chronic therapies often co-managed during perioperative planning (e.g., anticoagulation) and affect procedural planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33249`	Removal of permanent pacemaker pulse generator; replacement of pulse generator, same pulse generator system	Often used for replacement of transvenous pacemaker generators; clinically analogous when generator replaced in same pocket for transvenous systems.
`33258`	Removal of implantable defibrillator pulse generator; insertion of replacement pulse generator, same pulse generator system	Directly related code for replacement of subcutaneous or transvenous ICD generators in typical locations; may be used for non-substernal pockets.
`33224`	Removal of subcutaneous implantable defibrillator pulse generator; replacement with a new subcutaneous generator	Related when subcutaneous rather than substernal approach is used; addresses differences in device system.
`33233`	Insertion of new or replacement of transvenous ICD lead, single lead, with or without removal of old lead	Performed when lead revision or lead replacement is done at time of generator exchange.
`93288`	Programming device evaluation with iterative adjustment of parameters and/or cardioversion, with reprogramming and included follow-up interrogation	Used for extensive intraoperative and post-implant device programming and testing associated with generator replacement.

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Summary & Overview

CPT 0614T: Substernal Implantable Defibrillator Pulse Generator Replacement

Billing Code Overview

Service type: Device removal and replacement (pulse generator exchange)
Typical site of service: Inpatient or outpatient surgical setting (operating room or procedure suite)

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	Use when the generator replacement is partially reduced or not fully performed due to intraoperative findings.
`53`	Discontinued procedure	Use when the replacement is started but aborted for medical reasons.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct surgical components.
`66`	Surgical team (multiple surgeons)	Use when a surgical team approach is documented for complex extraction/reimplantation.
`78`	Unplanned return to OR following the initial procedure	Use for a related return to the OR for a complication from the generator replacement.
`79`	Unrelated procedure or service by same physician during postoperative period	Use for an unrelated procedure performed during the global period (Note: `79` is not in the provided list so it is not included).
`80`	Assistant surgeon	Use when an assistant surgeon provides documented assistance.
`81`	Minimum assistant surgeon	Use when a minimum assistant surgeon is documented.
`82`	Assistant surgeon (qualified resident)	Use when a qualified resident performs assisting duties where teaching facility billing rules allow.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician documents assistant-at-surgery services per payer rules.
`QK`	Medical direction of two, three, or four qualified providers	Use when the physician medically directs multiple qualified anesthesia providers during the case (if applicable to anesthesia billing).
`QX`	CRNA service with medical direction by physician	Use when a certified registered nurse anesthetist provides anesthesia with medical direction.
`QY`	Medical direction of one CRNA by an anesthesiologist	Use when anesthesiologist directs a single CRNA.
`TG`	Via telemedicine (general)	Use when preoperative or postoperative evaluation is provided via telemedicine per payer policy.

Taxonomy Code	Specialty	Notes
`208D00000X`	Cardiovascular Disease (Cardiologist)	Electrophysiologists/cardiologists manage device programming and follow-up.
`207RH0000X`	Thoracic Surgery	Surgeons performing chest wall pocket access and generator replacement when thoracic approach required.
`207L00000X`	Internal Medicine (Hospitalist)	Manages perioperative medical optimization, comorbid conditions.
`2084P0800X`	Cardiac Electrophysiology	Electrophysiologists who commonly perform device replacements and lead management.
`207K00000X`	Physician Assistant	PAs often assist intraoperatively and in device clinic follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z45.010`	Encounter for adjustment and management of automatic implantable cardiovascular defibrillator [AICD]	Common post-implant or device replacement management and programming encounters.
`Z45.018`	Encounter for adjustment and management of other heart assist devices and implantable cardioverter-defibrillator	Used for device management and follow-up related to ICD systems.
`T82.198A`	Other mechanical complication of other cardiac electronic device, initial encounter	Applicable when device malfunction or mechanical complication prompts generator replacement.
`T82.199A`	Mechanical complication of unspecified cardiac device, initial encounter	Used if mechanical complication of device is nonspecific and leads to generator exchange.
`I49.01`	Ventricular fibrillation	Underlying arrhythmia indication for ICD therapy and device management.
`I46.9`	Cardiac arrest, cause unspecified	Clinical scenario where ICD therapy history or malfunction may necessitate generator replacement.
`Z98.890`	Other specified postprocedural states	Notes prior device implantation status relevant to generator replacement.
`Z79.899`	Other long term (current) drug therapy	Chronic therapies often co-managed during perioperative planning (e.g., anticoagulation) and affect procedural planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33249`	Removal of permanent pacemaker pulse generator; replacement of pulse generator, same pulse generator system	Often used for replacement of transvenous pacemaker generators; clinically analogous when generator replaced in same pocket for transvenous systems.
`33258`	Removal of implantable defibrillator pulse generator; insertion of replacement pulse generator, same pulse generator system	Directly related code for replacement of subcutaneous or transvenous ICD generators in typical locations; may be used for non-substernal pockets.
`33224`	Removal of subcutaneous implantable defibrillator pulse generator; replacement with a new subcutaneous generator	Related when subcutaneous rather than substernal approach is used; addresses differences in device system.
`33233`	Insertion of new or replacement of transvenous ICD lead, single lead, with or without removal of old lead	Performed when lead revision or lead replacement is done at time of generator exchange.
`93288`	Programming device evaluation with iterative adjustment of parameters and/or cardioversion, with reprogramming and included follow-up interrogation	Used for extensive intraoperative and post-implant device programming and testing associated with generator replacement.