Is $797.95 what a practice actually receives?

It's the national allowed amount — the starting point. Medicare pays 80% of it ($638.36) and the patient owes 20% coinsurance ($159.59). Sequestration trims Medicare's share by about 2%, and your locality's GPCIs scale the total up or down. What lands is practice revenue covering staff, space, equipment, and billing — not clinician take-home pay.

What's the limiting charge for 33249?

$871.76 in the office setting — the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $797.95 Medicare amount. The non-participating amount is 95% of the fee schedule rate ($758.05), and the statutory cap is 115% of that.

Why would a Medicare claim for 33249 be denied or paid less?

Each item below comes from a CMS indicator on this page — not general billing advice. 33249 carries a 90-day global period — routine post-operative care within that window is included in the surgical payment rather than paid on its own claim. Bilateral surgery: no bilateral adjustment. Assistant at surgery: never separately payable. Co-surgeons: payable with documentation. Team surgery: not permitted. Multiple procedures: standard reduction applies. Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

What is a 33249 visit in patient-friendly terms?

In plain terms: Placement of a complete implantable cardioverter-defibrillator. A pulse generator is set in a pocket under the skin below the collarbone and connected to one or two leads that are threaded through a vein into the right side of the heart. The device watches every beat and delivers a shock or a burst of rapid pacing when it sees a dangerous fast rhythm, and it paces the heart if the rate falls too low. This entry covers the whole system going in through the veins, whether one chamber or two are wired, and applies to replacing an entire system as well as to a first implant. Think of someone whose heart function has stayed low on echo despite months of medication, who is offered a defibrillator as insurance against a rhythm that could stop the heart. The implant is done under sedation through a small incision near the shoulder, usually with an overnight stay, and the visible result is a firm lump under the skin about the size of a matchbox. You'll typically see CPT 33249 on a bill or explanation of benefits (EOB) when a clinician performs or bills for this service.

I'm a patient and saw 33249 on a bill — what will I owe?

On traditional Medicare, you typically owe 20% coinsurance — about $159.59 of the office amount — once your annual Part B deductible is met. Supplemental coverage (Medigap, Medicaid, or a retiree plan) often picks up that share. With private insurance, your cost follows your plan's negotiated rate, deductible, and copay. Your explanation of benefits (EOB) carries the exact split; the provider's bill won't.

Implantable Defibrillator System Placement

CPT 33249

Performed for patients at real risk of sudden cardiac death, such as a heart that pumps weakly after a heart attack or from cardiomyopathy, or someone who has already survived a life-threatening ventricular rhythm.

Office (non-facility)

$797.95

Where the non-facility amount comes from

Physician relative value file (PPRRVU) CMS download page PPRRVU2026_Jan_nonQPP.csv in rvu26a-updated-12-29-2025.zip · row 3,773 hcpcs = 33249 (col 1) · status_code = A (col 4) · work_rvu = 14.55 (col 6) · pe_rvu_nonfacility = 5.91 (col 7) · pe_rvu_facility = 5.91 (col 9) · mp_rvu = 3.43 (col 11)
Physician relative value file (PPRRVU) CMS download page PPRRVU2026_Jan_nonQPP.csv in rvu26a-updated-12-29-2025.zip · row 11 conversion_factor = 33.4009 (col 26)

(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor

= (14.55 × 1.000 + 5.91 × 1.000 + 3.43 × 1.000) × $33.4009 = $797.95

In a doctor’s own office or clinic

Facility

$797.95

Where the facility amount comes from

Physician relative value file (PPRRVU) CMS download page PPRRVU2026_Jan_nonQPP.csv in rvu26a-updated-12-29-2025.zip · row 3,773 hcpcs = 33249 (col 1) · status_code = A (col 4) · work_rvu = 14.55 (col 6) · pe_rvu_nonfacility = 5.91 (col 7) · pe_rvu_facility = 5.91 (col 9) · mp_rvu = 3.43 (col 11)
Physician relative value file (PPRRVU) CMS download page PPRRVU2026_Jan_nonQPP.csv in rvu26a-updated-12-29-2025.zip · row 11 conversion_factor = 33.4009 (col 26)

(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor

= (14.55 × 1.000 + 5.91 × 1.000 + 3.43 × 1.000) × $33.4009 = $797.95

In a hospital, surgery center, or other facility

This is the national Q1 2026 rate, before the ~2% sequestration cut · adjust for your locality

See everything that changed in Q1 2026 Get alerts for this code

How much did Medicare pay for CPT 33249 in Q1 2026?

Medicare paid $797.95 for CPT 33249 in the office (non-facility) setting and $797.95 in a facility under the Q1 2026 Physician Fee Schedule, effective January 2026. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This is a 8.4% decrease from the previous quarter.

CPT 33249

How much did Medicare pay for CPT 33249 in Q1 2026?

Rates by locality