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See a sample rate comparisonHCPCS C7538 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
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)
| Key Fact | Detail |
|---|---|
| Service Type | Outpatient PPS Miscellaneous Surgical Procedures |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for C7538 |
National average reimbursement for HCPCS C7538 by major payers:
$386.94
$N/A
$30,784.74
$N/A
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HCPCS C7538
5 of 25 sample ratesHigher to lower in this preview
The Medical Center Of Central Georgia Inc, Atrium Health Navicent The Medical Center
Medical Center Of Central Georgia Inc
$21,882.00Published rateWellstar North Fulton Hospital, Inc, Wellstar North Fulton Hospital
Wellstar North Fulton Hospital Inc
$6,532.00Published rateMaricopa County Special Heallth Care District, Valleywise Health
$1,762.00Published rateLafayette Surgery Center Limited Partnership
$1,653.00Published rateOphthalmic Outpatient Surgery Center Partners, LLC, Outpatient Surgery Center For Sight
Ophthalmic Outpatient Surgery Center Partners LLC
$434.00Published rate
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See a sample payer proposalHCPCS C7538 vs. Other Miscellaneous Surgical Procedures Codes
The HCPCS C7538 code is part of the Outpatient PPS services used for Miscellaneous Surgical Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS C7538 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| C7537-HCPCS | Moderate | Insertion of new or replacement of permanent pacemaker with atrial 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-HCPCS | Moderate | 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) |
| C7539-HCPCS | Moderate | Insertion of new or replacement of permanent pacemaker with atrial and 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 (eg, for upgrade to dual chamber system) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C7538. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C7538 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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