(2023) Pacemaker Coding Guidelines (CPT 33206, CPT 33207 & CPT 33208)

Pacemakers can be covered by Medicare when reported correctly. The insertion or replacement of a pacemaker can be billed with CPT 33206, CPT 33207 and CPT 33208. The description of the pacemaker codes, billing guidelines, and reimbursement can be found below.

What Are Pacemakers?

Permanent cardiac pacemakers refer to a group of self-contained, battery-operated, implanted devices that send electrical stimulation to the heart through one or more implanted leads.

Single chamber pacemakers typically target either the right atrium or right ventricle. Dual chamber pacemakers stimulate both the right atrium and the right ventricle. 

33206 CPT Code Description & Guidelines

The CPT manual defines CPT 33206 as: Replacement of permanent pacemaker or insertion of new or with transvenous electrode or electrodes. Atrial.

The 33206 CPT code part of the Merit-Based Incentive Payment System. Report CPT 33206 when the services involve inserting or replacing a permanent pacemaker with transvenous electrodes in an atrium.

33207 CPT Code Description & Guidelines

The CPT manual defines CPT 33207 as: Replacement of permanent pacemaker or insertion of new or with transvenous electrode/electrodes. Ventricular.

The 33207 CPT code part of the Merit-Based Incentive Payment System. Report CPT 33207 when the services involve inserting or replacing a permanent pacemaker with transvenous electrodes in a ventricle.

33208 CPT Code Description & Guidelines

CPT 33208 is described as follows: Replacement of permanent pacemaker or insertion of new or with transvenous electrode or electrodes. Ventricular and atrial.

The 33208 CPT code part of the Merit Based Incentive Payment System. Be aware that this code include subcutaneous insertion of the pulse generator and transvenous placement of electrode/electrodes.

Use CPT 33208 when the services involve inserting or replacing a permanent pacemaker with transvenous electrodes in the right atrium and right ventricle.

Don’t report CPT 33208 for removal and replacement of pacemaker pulse generator and transvenous electrode or electrodes. Report CPT 33233 with CPT 33235 or CPT 33235 and CPT 33206, CPT 33207 and CPT 33208.

Do not report the 33208 CPT code with CPT 33217 & 33216.

Implantation Procedure Pacemaker

The implantation procedure of CPT 33206, CPT 33207, and CPT 33208 is typically performed under local anesthesia and requires only a brief hospitalization.

A catheter is inserted into the chest, and the pacemaker’s leads are threaded through the catheter to the heart’s appropriate chamber(s).

The surgeon then makes a small “pocket” in the pad of the flesh under the skin on the upper portion of the chest wall to hold the power source. The pocket is then closed with stitches. 

Reimbursement For CPT 33206, CPT 33207 & CPT 33208

CPT 33206, CPT 33207, and CPT 33208 can be reimbursed in the following cases. The following indications can be covered for implanted permanent single-chamber or dual-chamber cardiac pacemakers: 

1. Documented non-reversible symptomatic bradycardia due to sinus node dysfunction.  
2. Documented non-reversible symptomatic bradycardia due to second-degree and/or third degree atrioventricular block.

CPT 33206, CPT 33207, and CPT 33208 can not be reimbursed in the following cases.

The following indications can not be covered for implanted permanent single-chamber or dual-chamber cardiac pacemakers: 

• Reversible causes of bradycardia such as electrolyte abnormalities, medications or drugs, and hypothermia. 
• Asymptomatic first-degree atrioventricular block. 
• Asymptomatic sinus bradycardia. 
• Asymptomatic sino-atrial block or asymptomatic sinus arrest. 
• Ineffective atrial contractions (e.g., chronic atrial fibrillation, flutter, or giant left atrium) without symptomatic bradycardia. 
• Asymptomatic second-degree atrioventricular block of Mobitz Type I unless the QRS complexes are prolonged or electrophysiological studies have demonstrated that the block is at or beyond the level of the His Bundle (a component of the heart’s electrical conduction system). 
• Syncope of undetermined cause. 
• Bradycardia during sleep. 
• Right bundle branch block with left axis deviation (and other forms of fascicular or bundle branch block) without syncope or other symptoms of intermittent atrioventricular block.
• Asymptomatic bradycardia in post-myocardial infarction patients about to initiate long-term beta-blocker drug therapy. 
• There is frequent supraventricular tachycardias, except where the pacemaker is specifically for controlling tachycardia. 
• A clinical condition in which pacing takes place only intermittently and briefly, and which is not associated with a reasonable likelihood that pacing needs will become prolonged.