2025 CPT code 33274
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Cardiovascular Surgery - Pacemaker or Implantable Defibrillator Procedures Surgery Feed
Transcatheter insertion or replacement of a permanent leadless pacemaker in the right ventricle; includes imaging guidance and device evaluation.
Modifiers may apply depending on the circumstances of the procedure. For example, modifier 59 may be appropriate if additional procedures were performed that were distinct and separately identifiable.
Medical necessity is determined based on the patient's clinical presentation and the need for permanent pacing support.Documentation must support the need for a pacemaker, the appropriateness of a leadless device, and the lack of response to alternative treatments.
The cardiologist or cardiac electrophysiologist is responsible for the implantation of the leadless pacemaker. This includes patient selection, procedural execution, post-procedure monitoring, and patient education.
- Surgery
- 33274 falls under the broader category of Cardiovascular System procedures, specifically pacemaker and defibrillator implantations and revisions.
In simple words: The doctor puts in or replaces a tiny pacemaker inside the heart's lower right chamber through a small tube inserted in a vein. This includes using imaging to guide the placement and checking the pacemaker's function.
This CPT code encompasses the transcatheter insertion or replacement of a permanent leadless pacemaker within the right ventricle.The procedure includes imaging guidance (such as fluoroscopy, venous ultrasound, ventriculography, and femoral venography) and device evaluation (including interrogation or programming) if performed.These ancillary services are bundled into the code and should not be reported separately. The leadless pacemaker is a self-contained device implanted directly into the ventricle using a catheter, eliminating the need for external leads.
Example 1: A 72-year-old male patient presents with symptomatic bradycardia unresponsive to medication. A leadless pacemaker is implanted via the transcatheter approach in the right ventricle. , An 80-year-old female patient with a previously implanted leadless pacemaker requires replacement due to battery depletion. The procedure is performed using the same transcatheter technique. , A 65-year-old patient with a history of heart failure and AV block is found to have a malfunctioning leadless pacemaker. The malfunctioning device is explanted, and a new leadless pacemaker is implanted.
Detailed history and physical examination, including documentation of the indication for implantation (e.g., symptomatic bradycardia, AV block); consent form; pre-procedure and post-procedure ECGs; echocardiogram (if needed); fluoroscopy images; pacemaker interrogation report; and post-procedure patient education.
** Payer policies regarding coverage for leadless pacemakers may vary.Always confirm coverage prior to performing the procedure.Pre-authorization may be required depending on the payer.
- Revenue Code: The specific revenue codes will vary depending on the payer and place of service.
- RVU: RVUs vary based on geographical location and payer; consult your local Medicare Administrative Contractor (MAC) for the most current RVU values and payment rates.Facility and non-facility rates differ.
- Global Days: The global surgical period is not explicitly defined for this code. Consult payer-specific guidelines for details on post-operative care included in the payment.
- Payment Status: Active; however, coverage may vary depending on payer and the specific clinical scenario.
- Modifier TC rule: A Technical Component (TC) modifier is not applicable to this code.
- Fee Schedule: Historical fee schedules are not available in the provided text; refer to your payer's historical fee data.
- Specialties:Cardiology, Cardiac Electrophysiology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center