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    v1.0.28
    OpenPayerBilling CodesPacemaker or Implantable Defibrillator ProceduresCPT cpt-33235-pacemaker-lead-removal-generator-pocket-exploration
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    CPT 33235: Removal of Two Pacemaker Leads from Pocket

    Medicare pays $574 on average nationally for this procedure.

    CPT code 33235 describes a surgical procedure in which the provider makes an incision to open the pacemaker pocket and disconnects and removes two electrode leads from the pacemaker generator; service type: lead extraction/removal procedure, typical site of service: operating room or procedure suite for a surgical pocket revision and lead removal under sterile conditions.

    For related coverage guidance, see recent payer policy updates: Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA), Cardiovascular Disease Risk Assessment, Biomarkers for Myocardial Infarction and Chronic Heart Failure.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 72-year-old male with a previously implanted dual-lead pacemaker presents for elective removal of the generator and extraction of two transvenous leads due to device infection of the pocket with erythema, drainage, and positive blood cultures. Preoperative evaluation includes device interrogation, chest radiograph to confirm lead position, review of anticoagulation, and informed consent discussing risks of lead removal. In the operating room or cardiac catheterization lab under monitored anesthesia care or general anesthesia, the provider makes an incision over the existing pacemaker pocket, opens the pocket, disconnects the generator from the two leads, and removes both leads through the pocket tract. Hemostasis is achieved, the pocket is irrigated, and a decision is made to place a new device—either in a contralateral pocket or after an interval—based on infection status. Postoperative management includes wound care, antibiotics as indicated, device reimplant timing planning, and monitoring for complications such as lead fracture, bleeding, pneumothorax, or cardiac tamponade.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    33232Removal of pacemaker pulse generator only; without lead removalPerformed when only the generator is removed and leads are left in place; contrasted with 33235 which includes lead removals
    33234Removal of pacemaker lead(s) via transvenous extraction, single leadRelated when only a single lead extraction is required; 33235 describes removal of two leads
    33240Revision or relocation of permanent pacemaker pulse generator, without lead replacementMay occur when pocket revision or relocation is performed instead of full extraction
    33249Repositioning of existing pacemaker lead, without replacementPerformed when leads are repositioned rather than fully removed
    33206Insertion of temporary transvenous pacing electrode lead, including connection to external pulse generatorMay be used pre- or post-extraction if temporary pacing support is required

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    208600000XSurgery PhysicianA general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
    246QI0000XImmunology Pathology Specialist/TechnologistTechnologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology
    1223D0004XDental AnesthesiologyA dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years durati…
    171400000XHealth & Wellness CoachThe Health & Wellness Coach is trained in motivational theories, strategies, and communication techniques, which are used to assist patients to develo…
    103T00000XPsychologistA psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
    347E00000XTransportation BrokerAn organization that provides transportation for individuals who need access to medical care or services and have no other means of transportation. Tr…

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    A41.9Sepsis, unspecified organism
    B37.7Candidal sepsis
    D70.9Neutropenia, unspecified
    I21.9Acute myocardial infarction, unspecified
    I25.10Atherosclerotic heart disease of native coronary artery without angina pectoris
    I42.0Dilated cardiomyopathy
    I42.8Other cardiomyopathies
    I45.10Unspecified right bundle-branch block
    I45.6Pre-excitation syndrome
    I46.9Cardiac arrest, cause unspecified

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: Cardiology1 / 2

    10 rows

    PolicyPayerEffective Date
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Cardiovascular Disease Risk Assessmentblue cross blue shield - louisiana2026-09-15
    Cardiovascular Disease Risk AssessmentBlue Cross Blue Shield - New Mexico2026-09-04
    Computed Tomography to Detect Coronary Artery CalcificationBluecross Idaho2026-09-01
    Intracoronary Drug Delivery Balloon ProceduresBlue Cross Blue Shield - Rhode Island2026-09-01
    Cardiac Imaging Guidelinesevicore2026-09-01
    Percutaneous Left Atrial Appendage Closure Device for Stroke PreventionAmbetter Georgia2026-08-26

    Related Codes

    CPT-33202-EPICARDIAL-ELECTRODE-INSERTION-OPEN-INCISION

    CPT 33202: Epicardial Electrode Placement via Open Incision

    CPT-33203-ENDOSCOPIC-EPICARDIAL-ELECTRODE-INSERTION

    CPT 33203: Epicardial Electrode Placement via Endoscopic Approach

    CPT-33206-PERMANENT-PACEMAKER-GENERATOR-ATRIAL-LEAD-INSERTION

    CPT 33206: Permanent Pacemaker Generator Insertion with Atrial Lead

    CPT-33207-PERMANENT-PACEMAKER-RIGHT-VENTRICLE-IMPLANT

    CPT 33207: Permanent Pacemaker Insertion with Right Ventricular Lead

    CPT-33208-PERMANENT-PACEMAKER-RIGHT-ATRIAL-AND-VENTRICULAR-LEADS

    CPT 33208: Permanent Pacemaker Insertion, Atrial and Ventricular Leads

    CPT-33210-TEMPORARY-PACEMAKER-INSERTION-REPLACEMENT

    CPT 33210: Temporary Pacemaker Insertion or Replacement

    CPT-33211-TEMPORARY-TRANSVENOUS-DUAL-CHAMBER-PACING

    CPT 33211: Temporary Transvenous Dual-Chamber Pacing Electrodes

    CPT-33212-PACEMAKER-PULSE-GENERATOR-SINGLE-CHAMBER-IMPLANTATION

    CPT 33212: Single‑Chamber Pacemaker Pulse Generator Placement

    CPT-33213-DUAL-PACEMAKER-PULSE-GENERATOR-INSERTION

    CPT 33213: Dual-Chamber Pacemaker Pulse Generator Insertion

    CPT-33214-PACEMAKER-SINGLE-TO-DUAL-CHAMBER-CONVERSION

    CPT 33214: Conversion of Single-Chamber Pacemaker to Dual-Chamber System

    Showing 1–10 of 38

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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