CPT 33208 represents the insertion of a new or replacement permanent pacemaker with dual transvenous electrodes (atrial and ventricular). It is a major surgical procedure with a 90-day global period.
Bundled Services (Do Not Unbundle)
Medicare strictly bundles several intraoperative services into 33208. You cannot separately bill for:
- Fluoroscopy (e.g., 77001, 76000) used for lead placement.
- Local anesthesia or conscious sedation provided by the surgeon.
- Pocket creation or skin closure.
Medical Necessity
Medicare requires specific diagnoses for permanent pacemakers, such as Sick Sinus Syndrome (I49.5) or complete heart block (I44.2). Ensure your LCD criteria are met.
NCCI and Global Period Modifiers
Because 33208 has a 90-day global period, any unrelated E/M visits during this time must be billed with Modifier 24. Any related return to the OR for complications (e.g., lead displacement) requires Modifier 78.