Insj/rplc cardiac modulj sys
Cardiac device implantation procedures with generator and electrode components range from $25,986 to $32,062 depending on facility type, making bill verification essential given the potential $6,076 difference.
About the analyst
Michael Glenn reviews CMS datasets and drug pricing at BillRazor Research. He focuses on NADAC acquisition costs and procedure coding accuracy. Expertise: drug pricing, NADAC data, CPT coding.
This procedure involves surgically placing or replacing a cardiac modulation device, which includes both the battery-powered generator and the electrode that delivers electrical signals to the heart. Patients with certain heart rhythm disorders or heart failure typically receive this treatment. Code 0408T is a Category III temporary code, meaning reimbursement policies vary significantly between insurers and documentation requirements are often more stringent.
Non-facility rate
$99
Office setting benchmark
Data sources
4
23 data points
Key insights for CPT 0408T
ASC vs hospital outpatient savings
$6,076Having this done at an ambulatory surgery center costs $25,986 vs $32,062 at a hospital outpatient
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Non-facility (office) | $99 | Lowest |
| Outpatient (APC) | $32,062 | +32285% |
| Ambulatory surgery (ASC) | $25,986 | +26148% |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use