CPT 33244 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 33244: Implantable Cardioverter-Defibrillator Removal with Lead Extraction

CPT code 33244 covers the surgical removal of a single- or dual-chamber implantable cardioverter-defibrillator (ICD) and transvenous extraction of its lead(s). This procedure is clinically important for device malfunction, elective system revision, or device-related infection, and it carries significant implications for patient safety, perioperative care, and reimbursement across national payers. Because lead extraction can be complex and resource-intensive, accurate coding is essential for appropriate payment and clinical documentation.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise understanding of what CPT code 33244 represents, the typical clinical settings and service type, and the kinds of benchmarks and policy considerations that commonly accompany complex device removal procedures. The publication will also summarize coding context, common modifiers used with surgical device procedures (when available), and relevant clinical contexts such as indications for removal and settings where the procedure is performed.

This national-level overview is intended to inform billing, clinical documentation, and policy discussions by clarifying the code’s clinical meaning, typical sites of service, and the payer landscape relevant to device removal and lead extraction procedures. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33244CPTimplantable-cardioverter-defibrillatorlead-extractiondevice-removalcardiac-surgeryhospital-procedurestransvenous-extraction

Billing Code Overview

CPT code 33244 describes the surgical removal of a single- or dual-chamber implantable cardioverter-defibrillator (ICD) device and its transvenous lead(s). The procedure involves incising the chest over the device pocket, disconnecting and removing the pulse generator, and extracting the electrode lead(s) through the venous system.

Service type: Device removal with transvenous lead extraction
Typical site of service: Inpatient or outpatient surgical setting, commonly performed in an operating room or catheterization laboratory where transvenous extraction can be performed under monitored anesthesia care or general anesthesia

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with ischemic cardiomyopathy and a previously implanted single- or dual-chamber implantable cardioverter-defibrillator (ICD) presents with pocket infection characterized by erythema, drainage, and positive blood cultures. The electrophysiology team schedules removal of the ICD and transvenous lead extraction under monitored anesthesia care or general anesthesia. The clinical workflow includes preoperative assessment (device interrogation, chest radiograph, vascular imaging if needed), informed consent, perioperative antibiotics, pocket incision and device explantation, transvenous lead extraction using traction or extraction tools, intraoperative fluoroscopic and hemodynamic monitoring, inspection of the pocket for residual infected tissue, culture of pocket contents, and post-procedure monitoring for bleeding, pneumothorax, or hemodynamic instability. The patient either receives a new device after infection control or remains without a device when clinically indicated, with documentation of device explantation details, number of leads removed, extraction technique, and any complications.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no special modifier applies to the service.
`11`

CPT 33212: Pacemaker Pulse Generator Placement, Single-Chamber

CPT-33225-LEFT-VENTRICULAR-PACING-LEAD-PLACEMENT-ADD-ON

CPT 33225: Left Ventricular Pacing Lead Placement (Add-On)

CPT-33227-PACEMAKER-PULSE-GENERATOR-REPLACEMENT-SINGLE-CHAMBER

CPT 33227: Pacemaker Pulse Generator Removal and Replacement, Single‑Chamber

CPT-33240-IMPLANTABLE-CARDIOVERTER-DEFIBRILLATOR-GENERATOR-PLACEMENT-SINGLE-LEAD

CPT 33240: Implantable Cardioverter‑Defibrillator Pulse Generator Placement

CPT-33210-TEMPORARY-PACEMAKER-INSERTION-REPLACEMENT

CPT 33210: Temporary Pacemaker Insertion or Replacement

33206-INSERTION-OF-NEW-OR-REPLACEMENT-OF-PERMANENT-PACEMAKER-WITH

CPT 33206: Insertion of Permanent Atrial Pacemaker

CPT-33229-PACEMAKER-PULSE-GENERATOR-REPLACEMENT-MULTICHAMBER

CPT 33229: Pacemaker Pulse Generator Removal and Replacement

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

CPT 33202: Epicardial and Pericardial Electrode Insertion

CPT-33235-PACEMAKER-LEAD-REMOVAL-GENERATOR-POCKET-EXPLORATION

CPT 33235: Pacemaker Lead Removal and Generator Pocket Exploration

CPT-33243-THORACOTOMY-EXPLANTATION-DEFIBRILLATOR-ELECTRODE

CPT 33243: Thoracotomy with Explantation of Defibrillator Electrode

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Taxonomy Code	Specialty	Notes
207RP0228X	Cardiac Electrophysiology	Electrophysiologists most commonly perform ICD and lead extraction procedures.
207K00000X	Cardiovascular Disease (Cardiology)	Interventional cardiologists or cardiologists with device expertise perform or co-manage these cases.
208100000X	Thoracic Surgery	Thoracic surgeons may be involved for complex extractions or surgical lead removal.
2080P0202X	General Surgery	General surgeons may assist in pocket exploration or infected-tissue management in some settings.
333600000X	Cardiac Surgery	Cardiac surgeons may be involved for open surgical removal or management of complications.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T82.7XXA`	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter	Common indication for device and lead removal when pocket infection or endocarditis is present.
`I42.8`	Other cardiomyopathies	Underlying cardiomyopathy often underlies ICD placement; may be present in patients requiring device removal and reassessment.
`I46.9`	Cardiac arrest, cause unspecified	History of prior malignant ventricular arrhythmias or arrest is a typical original indication for ICD implantation.
`I49.01`	Ventricular fibrillation	A primary arrhythmic indication for ICD therapy; related to patients who have ICDs placed and later require removal.
`I50.22`	Chronic systolic (congestive) heart failure	Heart failure with reduced ejection fraction is a common indication for ICD implantation and subsequent device management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33241`	Removal of permanent pacemaker pulse generator; single or dual chamber	May be performed for pacemaker systems; related when device type is pacemaker rather than ICD or when pulse generator removal is required without lead extraction.
`33234`	Insertion or replacement of permanent pacemaker pulse generator; single or dual chamber	Commonly performed before or after extraction when device replacement is indicated, or for reimplantation after infection is cleared.
`33230`	Insertion or replacement of permanent pacemaker chest wall	Related as part of device management and reimplantation workflows.
`0589T`	Lead extraction, other than pacemaker or ICD leads, percutaneous (Category III)	May be used for certain extraction techniques or additional lead types; adjunctive to `33244` when multiple extraction methods are documented.
`33245`	Removal of implantable defibrillator lead, open; single or dual lead	Related when lead removal requires an open surgical approach rather than transvenous extraction; used if conversion to open procedure occurs.

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