C7540 Rmv&rplc pm dul w/l vnt lead

Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator, dual lead system, with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)

Medically Unlikely Edits (effective October 1, 2026)

Payer policies and prior authorization for C7540

Payer coverage policies that name C7540

C7540 appears in 5 coverage policies from Aetna, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

PayerPolicyRole in policyReviewedDocument
AetnaBody Surface Potential Mapping (0705)listed, no stanceNov 24, 2025payer document
AetnaCardiac Resynchronization Therapy and Other Pacing/Defibrillator Treatments for Heart Failure (0610)covered if criteria are metSep 18, 2026payer document
AetnaCardioverter-Defibrillators (0585)covered if criteria are metApr 22, 2026payer document
Blue Shield of CaliforniaBiventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure (2.02.10)listed, no stancepayer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure (MED202.054)
CPT Codes 33202, 33203, 33207, 33208, 33211, 33213, 33214, 33217, 33220,
listed, no stanceOct 1, 2026payer document

Medicaid fee-for-service

  • IN: $0.00 (professional, facility), effective Jan 1, 2023
  • KS: $6001.41 (asc, facility), effective Jan 1, 2023
  • KY: $10660.14 (asc), effective Jan 1, 2026
  • MA: $8574.26 (asc), effective May 1, 2026
  • ND: $6511.55 (physician, facility), effective Aug 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.