CPT 33264 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 33264: Implantable Defibrillator Pulse Generator Removal and Replacement

CPT code 33264 captures the surgical removal and replacement of an implantable defibrillator pulse generator in patients with leads to at least three cardiac chambers. This procedure is clinically important for maintaining or restoring device function when a pulse generator fails, reaches end of service life, or is implicated in device-related infection. Nationally, device replacement procedures carry implications for acute care resource use, perioperative management, and device registry reporting.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage and billing benchmarks, common modifier usage, and clinical context relevant to electrophysiology and cardiac surgery service lines. Readers will find a concise explanation of the service description and typical sites of care, a summary of payer coverage considerations, and pointers to related service coding where available.

This overview is intended for revenue cycle professionals, coding and compliance teams, and clinicians involved in device management. It focuses on the code definition, clinical scenario, and where the service is commonly performed, providing a foundation for coding, billing, and administrative workflows. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare33264CPTimplantable-defibrillatorpulse-generator-replacementelectrophysiologycardiac-device-surgerydevice-exchangecardiologysurgical-procedures

Billing Code Overview

CPT code 33264 describes the removal of a previously implanted defibrillator pulse generator and replacement with a new pulse generator for a patient with leads to at least three chambers of the heart. This procedure involves explanting the existing implantable cardioverter-defibrillator (ICD) pulse generator and inserting a replacement device while the transvenous leads for three-chamber therapy remain in place.

Service type: Surgical device revision/replacement of an implantable defibrillator pulse generator
Typical site of service: Hospital inpatient or outpatient surgical setting (electrophysiology lab or operating room)

Clinical & Coding Specifications

Clinical Context

A 68-year-old man with ischemic cardiomyopathy and prior implantation of a CRT‑D (cardiac resynchronization therapy defibrillator) presents with progressive device malfunction characterized by recurrent inappropriate shocks and non‑functioning pulse generator diagnostics. He has transvenous leads coursing to the right atrium, right ventricle and a left ventricular coronary sinus branch (three‑chamber system). The electrophysiology team schedules replacement of the implantable cardioverter‑defibrillator pulse generator under monitored anesthesia care in the cardiac catheterization/EP lab. The clinical workflow includes preoperative device interrogation, informed consent, antibiotic prophylaxis, sterile preparation, incision over the device pocket, removal of the old generator from the header, connection and testing of the existing leads to the new pulse generator, intraoperative sensing/threshold testing and defibrillation threshold testing as indicated, pocket closure, postoperative device interrogation and programming, and discharge with device follow‑up arranged. ICD‑10 diagnoses that commonly justify the procedure include lead or generator malfunction, device infection, and generator depletion requiring replacement.

Coding Specifications

Modifier	Description	When to Use
`00`	Invalid or not in use in current CMS modifier set	Data not available in the input

CPT 33258: Surgical Atrial Ablation with Extensive Atrial Reconstruction

CPT-33259-EXTENSIVE-ATRIAL-ABLATION-AND-RECONSTRUCTION

CPT 33259: Extensive Atrial Ablation and Reconstruction

CPT-33255-ATRIAL-ABLATION-AND-ATRIAL-RECONSTRUCTION-OFF-PUMP

CPT 33255: Atrial Ablation and Reconstruction, Off‑Pump

CPT-33257-ATRIAL-ABLATION-AND-RECONSTRUCTION-ADD-ON

CPT 33257: Atrial Tissue Ablation and Atrial Reconstruction (Add-On)

CPT-33267-LEFT-ATRIAL-APPENDAGE-EXCLUSION-OPEN-SURGERY

CPT 33267: Left Atrial Appendage Exclusion, Open Surgical Procedure

CPT-33256-ATRIAL-ABLATION-ATRIAL-RECONSTRUCTION

CPT 33256: Atrial Ablation with Left and Right Atrial Reconstruction

CPT-33250-CARDIAC-ARRHYTHMIA-ABLATION-NO-BYPASS

CPT 33250: Cardiac Arrhythmia Ablation Without Bypass

CPT-33251-CARDIAC-ABLATION-WITH-CARDIOPULMONARY-BYPASS

CPT 33251: Surgical Cardiac Ablation With Cardiopulmonary Bypass

CPT-33268-LEFT-ATRIAL-APPENDAGE-EXCLUSION-OPEN-SURGERY

CPT 33268: Left Atrial Appendage Exclusion, Open Cardiac Surgery

CPT-33261-CARDIAC-VENTRICULAR-ABLATION-CARDIOPULMONARY-BYPASS

CPT 33261: Surgical Ventricular Ablation with Cardiopulmonary Bypass

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Taxonomy Code	Specialty	Notes
207RH0000X	Cardiology	Electrophysiologists and invasive cardiologists perform device replacements and programming
2084P0800X	Cardiovascular Disease	Heart failure cardiologists manage device indications and follow up
208000000X	Internal Medicine	Hospitalist or proceduralist involvement for medical optimization and perioperative care
207K00000X	Family Medicine	May coordinate outpatient preoperative evaluation and follow up
208M00000X	Thoracic Surgery	Surgeons who may be involved in complex pocket revisions or infected device explantation

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	Device pocket or lead infection necessitating removal and replacement of pulse generator (often with staged explant/reimplant)
`T82.110A`	Breakage of cardiac electrode, initial encounter	Lead or electrode malfunction that prompts generator-lead system revision or replacement
`T82.198A`	Other mechanical complication of other cardiac and vascular devices, implants and grafts, initial encounter	Mechanical failure of generator components requiring replacement
`Z45.010`	Adjustment and management of cardiac pacemaker	Post‑procedure management and programming; often used in follow‑up claims for device programming and checks
`I50.22`	Chronic systolic (congestive) heart failure	Underlying cardiomyopathy indication for CRT‑D therapy and generator replacement
`I49.01`	Ventricular fibrillation	Arrhythmic indication for ICD therapy and reason for generator replacement if device malfunctioned
`Z98.890`	Other specified postprocedural states	Denotes presence of prior implanted cardiac device and history relevant to replacement

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33262`	Removal or replacement of permanent pacemaker pulse generator; with connection of existing leads	Performed for single‑ or dual‑chamber pacemaker systems; similar generator replacement workflow when leads are present
`33263`	Removal or replacement of implantable defibrillator pulse generator; with connection of existing leads, for fewer than three leads	CPT code for ICD generator replacement when fewer than three cardiac leads are present; closely related to `33264` which is for three or more leads
`33270`	Insertion or replacement of permanent pacemaker with transvenous lead(s)	Performed when new leads are placed or when generator replacement requires lead revision or new lead implantation
`33216`	Insertion of single transvenous electrode, temporary	May be used perioperatively for temporary pacing support if needed during generator replacement
`33249`	Interrogation device evaluation (in person) with programming when performed	Device interrogation and reprogramming are performed before and after generator replacement as part of standard workflow

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