Summary & Overview
CPT 0919T: Pulse Generator Removal, Cardiac Contractility Modulation–Defibrillator
CPT code 0919T identifies the surgical removal of the pulse generator from a permanent cardiac contractility modulation–defibrillation system. This explantation procedure is clinically significant as more complex implantable cardiac devices combine modulatory pacing with defibrillation capability; safe removal of the pulse generator may be required for device malfunction, infection, system upgrades, or end-of-life management. Nationally, the code is relevant for hospital surgical services and impacts inpatient and outpatient device-management workflows and billing practices. Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical intent, where the service is typically delivered, and which payers commonly reimburse for it. The publication also outlines billing considerations, common modifiers, and areas where policy updates or payer-specific rules could affect coverage and claims processing. Clinical context covers the nature of the implanted system and typical indications for generator explantation. Policy and billing sections summarize benchmarks and payer approaches to surgical device removal, plus operational notes for coding and charge capture. Data not available in the input is clearly identified where applicable.
Billing Code Overview
CPT code 0919T describes the removal of the pulse generator of a permanent cardiac contractility modulation–defibrillation system. This procedure involves explanting the implanted pulse generator component of a combined device that delivers cardiac contractility modulation therapy and defibrillation therapy.
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Service type: Surgical explantation of implanted cardiac device
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Typical site of service: Hospital inpatient or hospital outpatient surgical setting
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with ischemic cardiomyopathy and chronic heart failure has a previously implanted permanent cardiac contractility modulation–defibrillation (CCM‑D) system. The patient develops device-related complications including generator erosion and recurrent pocket infection with local tenderness and purulent drainage despite antibiotics. After multidisciplinary review, the decision is made to remove the pulse generator to control infection and prevent systemic spread. The procedure is performed in an operating room or cardiac electrophysiology lab under monitored anesthesia care or general anesthesia. Preoperative workflow includes device interrogation and imaging to document lead function, review of anticoagulation, informed consent, and perioperative antibiotics. Intraoperative steps include incision and pocket exploration, disconnection and removal of the pulse generator, hemostasis, cultures of the pocket if infected, and wound closure with or without delayed primary closure. Postoperative workflow includes device interrogation to confirm lead status (if leads are retained), wound care instructions, possible temporary external defibrillator support if needed, and coordination for replacement device planning if indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to remove the generator is substantially greater than usual (extensive adhesions, unexpected prolonged procedure). |