C7538 HCPCS code: Insertion of new or replacement of permanent pacemaker with ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system)
C7538 is the HCPCS Level II code for insertion of new or replacement of permanent pacemaker with ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system). In 2024 Medicare paid an average of $8,290.64 per service for C7538 across 39 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume rose 44% from 2023 to 2024 (27 to 39 services). In 2024, about 12 clinicians billed Medicare for C7538 for 39 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | C codes — Outpatient PPS (hospital outpatient temporary codes) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 11 — Priced using national relative value units (Physician Fee Schedule) |
| BETOS category | P2E |
| Added | 2023-01-01 |
| Last action effective | 2023-01-01 |
Who bills C7538 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 12 |
| Medicare beneficiaries | 39 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for C7538, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 27 | 27 | $9,839.73 | $7,839.79 |
| 2024 | 39 | 39 | $10,405.61 | $8,290.64 |
States with the most C7538 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Illinois | 25 | $8,612.95 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Anatomic Consideration |
| practitioner claims | 1 | Anatomic Consideration |
Medicare policy articles for this code
- A56391: Billing and Coding: Implantable Automatic Defibrillators (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A56391: Billing and Coding: Implantable Automatic Defibrillators (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
Covered diagnoses (73 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| G90.01 | Carotid sinus syncope | 1 |
| I25.2 | Old myocardial infarction | 1 |
| I25.5 | Ischemic cardiomyopathy | 1 |
| I42.0 | Dilated cardiomyopathy | 1 |
| I42.00 | Dilated cardiomyopathy, unspecified | 1 |
| I42.01 | Familial-genetic dilated cardiomyopathy | 1 |
| I42.09 | Other dilated cardiomyopathy | 1 |
| I42.1 | Obstructive hypertrophic cardiomyopathy | 1 |
| I42.2 | Other hypertrophic cardiomyopathy | 1 |
| I42.6 | Alcoholic cardiomyopathy | 1 |
Showing 10 of 73. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for C7538
- 2023-01-01: C7538 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code C7538?
C7538 is the HCPCS Level II code for insertion of new or replacement of permanent pacemaker with ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system). Short descriptor: "Insrt vent pm w/l vent lead".
How much does Medicare pay for C7538?
In 2024, the average Medicare payment was $8,290.64 per service (average allowed $10,405.61).
Does Medicare cover C7538?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for C7538?
Medicare policy articles that cite C7538 list 73 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include G90.01 (Carotid sinus syncope), I25.2 (Old myocardial infarction), I25.5 (Ischemic cardiomyopathy). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of C7538 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related C75 codes
- C7500 — Debridement, bone including epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, first 20 sq cm or less with manual preparation and insertion of deep (e.g., subfacial) drug-delivery device(s)
- C7501 — Percutaneous breast biopsies using stereotactic guidance, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral and bilateral (for single lesion biopsy, use appropriate code)
- C7502 — Percutaneous breast biopsies using magnetic resonance guidance, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral or bilateral (for single lesion biopsy, use appropriate code)
- C7503 — Open biopsy or excision of deep cervical node(s) with intraoperative identification (e.g., mapping) of sentinel lymph node(s) including injection of non-radioactive dye when performed
- C7504 — Percutaneous vertebroplasties (bone biopsies included when performed), first cervicothoracic and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance
- C7505 — Percutaneous vertebroplasties (bone biopsies included when performed), first lumbosacral and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance
- C7506 — Arthrodesis, interphalangeal joints, with or without internal fixation
- C7507 — Percutaneous vertebral augmentations, first thoracic and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (e.g., kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance
- C7508 — Percutaneous vertebral augmentations, first lumbar and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (e.g., kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance
- C7509 — Bronchoscopy, rigid or flexible, diagnostic with cell washing(s) when performed, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
- C7510 — Bronchoscopy, rigid or flexible, with bronchial alveolar lavage(s), with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
- C7511 — Bronchoscopy, rigid or flexible, with single or multiple bronchial or endobronchial biopsy(ies), single or multiple sites, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed
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Next steps
- Run a reimbursement report for a device billed under C7538
- Watch C7538 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for C7538
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.