A medical device system and associated method determine an implantable medical device state prior to implantation. An impedance monitoring module monitors for a change in impedance between a pair of electrodes coupled to the impedance monitoring circuit. The system includes an enclosure for carrying the implantable medical device. The enclosure has a surface having an electrical impedance. A control module is configured to detect one of a first pre-implant state and a second pre-implant state of the implantable medical device in response to the impedance monitoring module detecting a change in impedance between the electrodes and adjust operation of the implantable medical device in response to detecting the impedance change.