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CPT code 49083: Paracentesis, with imaging guidance2026 Medicare rate & RVUs in Puerto Rico

Report image-guided abdominal paracentesis when a clinician removes peritoneal fluid for diagnosis or symptom relief using imaging to guide needle placement.

CMS RVU26DEffective Oct 1, 2026One payment locality235.4K Medicare services in 2024

In Puerto Rico, Medicare pays $286.47 for 49083 in the office and $92.98 when it’s performed in a hospital or facility.

$286.47Office (non-facility)
$92.98Hospital or facility
+0.8%vs the national office rate ($284.24)

Check a contract rate as a % of Medicare · 49083 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 49083 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 49083 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 49083 covers

A clinician uses imaging, commonly ultrasound, to guide a needle or catheter into the peritoneal cavity and remove ascitic fluid. The procedure may obtain fluid for diagnostic testing or relieve symptoms from fluid accumulation, such as abdominal distention or discomfort. It is performed in settings including hospitals, outpatient departments, and offices by physicians or other qualified practitioners who perform paracentesis.

Select 49083 when imaging guidance is used; 49082 is the corresponding code for paracentesis without imaging guidance. Documentation should support the indication, fluid removal, and use of imaging to guide the procedure. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Puerto Rico compares for 49083

Across 109 of 109 payment localities, the office rate for 49083 runs from $250.93 in Arkansas to $381.90 in San Benito County, CA. Puerto Rico pays $286.47. The RVUs are the same everywhere; the geographic indexes change the dollars.

49083 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$286.47
  2. Los Angeles, CA · California$323.37+$36.90
  3. Washington, DC area · District of Columbia$326.30+$39.83
  4. Miami, FL · Florida$303.66+$17.19
  5. Chicago, IL · Illinois$294.84+$8.37
  6. Manhattan, NY · New York$326.88+$40.41
  7. Alaska · Alaska$327.44+$40.97

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

49083 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$254.69$87.22
ArkansasArkansas$250.93$86.53
ArizonaArizona$276.66$91.20
Bakersfield, CACalifornia$303.10$93.34
Chico, CACalifornia$302.46$92.70
El Centro, CACalifornia$302.49$92.73
Fresno, CACalifornia$302.46$92.70
Hanford, CACalifornia$302.46$92.70

49083 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$250.93

$342.18

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
49083 office rate range by state
State / territoryOffice rate rangeLocalities
AK$327.441
AL$254.691
AR$250.931
AZ$276.661
CA$302.46–$381.9029
CO$297.061
CT$303.351
DC$326.301
DE$281.311
FL$278.44–$303.663
GA$262.68–$289.242
GU$310.351
HI$310.351
IA$261.981
ID$263.581
IL$269.74–$295.844
IN$265.151
KS$260.401
KY$260.101
LA$259.56–$272.682
MA$295.10–$327.292
MD$286.86–$326.303
ME$264.62–$279.742
MI$266.69–$281.632
MN$285.451
MO$254.79–$274.083
MS$252.931
MT$284.231
NC$267.501
ND$280.081
NE$263.551
NH$292.061
NJ$307.04–$322.762
NM$268.051
NV$283.281
NY$271.55–$334.515
OH$265.851
OK$259.981
OR$281.31–$307.032
PA$266.46–$295.462
PR$286.471
RI$291.721
SC$267.071
SD$279.581
TN$261.691
TX$264.66–$295.878
UT$270.801
VA$278.57–$326.302
VI$286.471
VT$278.661
WA$294.65–$334.362
WI$270.481
WV$259.481
WY$282.421

See 49083 in every payment locality

How the 49083 rate is calculated

Each of 49083’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 49083

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.95

1.95 RVUs× 1.000 GPCI

Practice expense6.35

6.35 RVUs× 1.000 GPCI

Malpractice0.21

0.21 RVUs× 1.000 GPCI

Adjusted RVUs

8.5100

Conversion factor

$33.4009

Medicare rate

$284.24

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,771

Code
49083
Physician work
1.95
Practice expense
6.35
Malpractice
0.21

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 49083 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.95× 1.0001.9500
Practice expense6.35× 1.0116.4198
Malpractice0.21× 0.9850.2068
Total RVUs8.5767
Conversion factor× 33.4009

Office rate, Puerto Rico$286.47

Office: (1.95 × 1 + 6.35 × 1.011 + 0.21 × 0.985) × $33.4009 = $286.47

Facility: (1.95 × 1 + 0.62 × 1.011 + 0.21 × 0.985) × $33.4009 = $92.98

Open 49083 in the RVU calculator

Payment rules and modifiers for 49083

The CMS indicators that decide how 49083 is paid alongside other services.

CMS payment indicators · 49083

Paracentesis, with imaging guidance

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

49083 without 51 · national office

$284.24

Paracentesis, with imaging guidance

49083-51 · Second procedure: 50%

$142.12

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 49083

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 49083
CodeHow it relatesOffice range, Puerto Rico
Same family
49082Paracentesis, without imaging guidanceAbdominal paracentesis without imaging guidance.$247.24
Often billed with
88108Concentrated cytology, non-gynecologic specimenMay be reported for cytopathology of submitted fluid.$69.39
89051Body fluid count, with cell identificationMay be reported for cell count and differential on submitted body fluid.$5.60

How 49083 has changed in Puerto Rico

49083 · Office / nonfacility

$286.47

Effective 2026-10-01

The base rate is $7.93 higher than on 2025-10-01, moving from $278.54 to $286.47 (2.8%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $278.54changed to$286.47

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.00 changed to 1.95
    • Practice expense RVU 6.37 changed to 6.35
    • Malpractice RVU 0.20 changed to 0.21
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $291.33changed to$278.54

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.51 changed to 6.37

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $286.58changed to$291.33

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $301.60changed to$286.58

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.66 changed to 6.51
    • Malpractice RVU 0.19 changed to 0.20
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $299.90changed to$301.60

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $312.20changed to$299.90

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.78 changed to 6.66
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $318.32changed to$312.20

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.90 changed to 6.78
    • Malpractice RVU 0.17 changed to 0.19

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $310.69changed to$318.32

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 6.38 changed to 6.90
    • Malpractice RVU 0.18 changed to 0.17
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $305.68changed to$310.69

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 6.26 changed to 6.38
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $303.90changed to$305.68

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.22 changed to 6.26

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $265.78changed to$303.90

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.18 changed to 6.22
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $229.49changed to$265.78

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $229.67changed to$229.49

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 6.15 changed to 6.18
    • Malpractice RVU 0.19 changed to 0.18

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $228.52changed to$229.67

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $226.99changed to$228.52

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.20 changed to 6.15
    • Malpractice RVU 0.17 changed to 0.19
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $240.04changed to$226.99

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 7.39 changed to 6.20
    • Malpractice RVU 0.18 changed to 0.17
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $240.04

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$286.47$92.98RVU26D
2026-07-01$286.47$92.98RVU26C
2026-04-01$286.47$92.98RVU26B
2026-01-01$286.47$92.98RVU26A
2025-10-01$278.54$101.99RVU25D
2025-07-01$278.54$101.99RVU25C
2025-04-01$278.54$101.99RVU25B
2025-01-01$278.54$101.99RVU25A
2024-10-01$291.33$103.95RVU24D
2024-07-01$291.33$103.95RVU24C
2024-04-01$291.33$103.95RVU24B
2024-03-09$291.33$103.95RVU24AR
2024-01-01$286.58$102.25RVU24A
2023-10-01$301.60$105.88RVU23D
2023-07-01$299.90$105.73RVU23C
2023-04-01$299.90$105.73RVU23B
2023-01-01$299.90$105.73RVU23A
2022-10-01$312.20$107.44RVU22D
2022-07-01$312.20$107.44RVU22C
2022-04-01$312.20$107.44RVU22B
2022-01-01$312.20$107.44RVU22A
2021-10-01$318.32$107.64RVU21D
2021-07-01$318.32$107.64RVU21C
2021-04-01$318.32$107.64RVU21B
2021-01-01$318.32$107.64RVU21A
2020-10-01$310.69$112.43RVU20D
2020-07-01$310.69$112.43RVU20C
2020-04-01$310.69$112.43RVU20B
2020-01-01$310.69$112.43RVU20A
2019-10-01$305.68$112.25RVU19D
2019-07-01$305.68$112.25RVU19C
2019-04-01$305.68$112.25RVU19B
2019-01-01$305.68$112.25RVU19A
2018-10-01$303.90$112.85RVU18D
2018-07-01$303.90$112.85RVU18C
2018-04-01$303.90$112.85RVU18B
2018-01-01$303.90$112.85RVU18AR1
2017-10-01$265.78$105.72RVU17D
2017-07-01$265.78$105.72RVU17C
2017-04-01$265.78$105.72RVU17B
2017-01-01$265.78$105.72RVU17A
2016-10-01$229.49$97.98RVU16D
2016-07-01$229.49$97.98RVU16C
2016-04-01$229.49$97.98RVU16B
2016-01-01$229.49$97.98RVU16A
2015-10-01$229.67$98.44RVU15D
2015-07-01$229.67$98.44RVU15C
2015-04-01$228.52$97.95RVU15B
2015-01-01$228.52$97.95RVU15A
2014-10-01$226.99$97.34RVU14D
2014-07-01$226.99$97.34RVU14C
2014-04-01$226.99$97.34RVU14B
2014-01-01$226.99$97.34RVU14A
2013-10-01$240.04$95.18RVU13D
2013-07-01$240.04$95.18RVU13C
2013-04-01$240.04$95.18RVU13B
2013-01-01$240.04$95.18RVU13AR

Price 49083 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

49083 billing questions

When should 49083 be selected instead of 49082?

Use 49083 when imaging is used to guide the paracentesis. Use 49082 when the paracentesis is performed without imaging guidance.

Can the imaging guidance be reported separately?

Imaging guidance is part of 49083. Do not separately report a guidance service for the same needle placement.

Can modifier 50 be appended for fluid removed from both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.

What documentation supports 49083?

Document the clinical reason for drainage, that peritoneal fluid was removed, and that imaging was used to guide the procedure.

How is 49083 affected when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.

Can an assistant or co-surgeon be billed for this procedure?

Medicare does not pay an assistant at surgery for 49083. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 49083PPRRVU2026_Oct_nonQPP.csv, line 5,771 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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