Summary & Overview
CPT 33249: Implantation or Replacement of Permanent Defibrillator System
CPT code 33249 covers implantation or replacement of a permanent implantable cardioverter-defibrillator (ICD) system with single- or dual-chamber transvenous leads. This procedure is a critical intervention for patients at risk of life-threatening ventricular arrhythmias and is central to sudden cardiac death prevention strategies nationwide. The code captures both initial device implantation and replacement of malfunctioning or infected systems when transvenous leads are used.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings, typical sites of service, and common operational considerations tied to coding and billing workflows. The publication outlines benchmark elements such as common modifiers and related service-line considerations where available and highlights national policy and coverage themes that influence access to ICD therapy.
This resource assists billing managers, electrophysiology program directors, and revenue cycle teams in understanding the clinical scope represented by CPT code 33249, the payer landscape nationally, and the types of documentation and service contexts typically associated with this code. Data not available in the input will be noted as such in relevant sections.
Billing Code Overview
CPT code 33249 describes the replacement or implantation of a new permanent implantable cardioverter-defibrillator (ICD) system with single- or dual-chamber transvenous leads or electrodes. The procedure involves placing or exchanging a device that senses cardiac rhythm and delivers therapeutic shocks or antitachycardia pacing to terminate life-threatening arrhythmias.
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Service type: Implantation or replacement of a permanent defibrillator system with transvenous leads
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Typical site of service: Inpatient or outpatient hospital settings and specialized cardiac electrophysiology laboratories
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with ischemic cardiomyopathy (left ventricular ejection fraction 28%), a history of sustained ventricular tachycardia, and prior syncope is evaluated in the electrophysiology clinic. Device interrogation of his existing implantable cardioverter-defibrillator shows recurrent lead noise and failure to sense, and he reports a pocket site erythema concerning for infection. The electrophysiologist schedules the patient for replacement of the permanent transvenous ICD system with single- or dual-chamber leads under monitored anesthesia care in the hospital's cardiac electrophysiology lab or operating room. The clinical workflow includes pre-procedure device interrogation and imaging, informed consent, peri-procedural antibiotics, generator and lead removal as indicated, implantation of new single- or dual-chamber transvenous ICD leads and generator, intraoperative testing of lead thresholds and defibrillation safety margin testing as indicated, device programming, post-procedure chest radiograph, and device follow-up with wound checks and remote monitoring enrollment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician component of services (e.g., interpretation/testing by the physician separate from facility or technical services). |
50 |