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33208 CPT Code: Pacemaker Insertion Bundling Rules

Last Updated: March 24, 2026

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.

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2026 Medicare National Fee (33208): Non-Facility (Office): $491.26 · Facility (Hospital): $491.26
✓ 28 Medicare-Approved ICD-10 Diagnoses on file for 33208:

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

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Don't risk a denial. See if your ICD-10 code is on the approved Medicare LCD list.

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.

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