CPT code 49418: Peritoneal catheter, percutaneous tunneled placement2026 Medicare rate & RVUs in California
Report this service for initial percutaneous placement of a tunneled catheter into the peritoneal cavity when ongoing access, such as ascites drainage, is needed.
Medicare pays $1,011.35–$1,298.74 for 49418 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 49418 covers
This code covers percutaneous placement of a tunneled catheter through the abdominal wall into the peritoneal cavity. It provides ongoing peritoneal access, commonly for drainage of recurrent ascites, including malignant ascites. Interventional radiologists often perform the procedure; surgeons may also place the catheter. The catheter is tunneled, but this service does not include placement of a subcutaneous port.
Select the code when the record supports a new catheter placed percutaneously and tunneled into the peritoneal cavity. Document the indication, access route, tunneling, and final catheter position; distinguish a catheter with a port or an exchange of an existing catheter. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires medical-necessity documentation; 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.
Where 49418 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$1011.35 to $1298.74
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $1,012.68 | $174.37 |
| Chico, CA | $1,011.35 | $173.04 |
| El Centro, CA | $1,011.42 | $173.11 |
| Fresno, CA | $1,011.35 | $173.04 |
| Hanford, CA | $1,011.35 | $173.04 |
| Los Angeles, CA | $1,085.57 | $180.72 |
| Madera, CA | $1,011.35 | $173.04 |
| Marin County, CA | $1,270.20 | $191.72 |
| Merced, CA | $1,011.35 | $173.04 |
| Modesto, CA | $1,011.35 | $173.04 |
| Napa, CA | $1,193.57 | $185.46 |
| Oxnard, CA | $1,082.50 | $178.41 |
| Redding, CA | $1,011.35 | $173.04 |
| Rest of California | $1,011.35 | $173.04 |
| Riverside, CA | $1,016.14 | $177.83 |
| Sacramento, CA | $1,067.13 | $177.57 |
| Salinas, CA | $1,063.30 | $176.80 |
| San Benito County, CA | $1,298.74 | $195.78 |
| San Diego, CA | $1,092.71 | $177.91 |
| San Francisco, CA | $1,269.70 | $191.22 |
| San Luis Obispo, CA | $1,045.58 | $174.38 |
| Santa Clara County, CA | $1,296.69 | $193.74 |
| Santa Cruz, CA | $1,106.58 | $177.25 |
| Santa Maria, CA | $1,068.48 | $176.63 |
| Santa Rosa, CA | $1,118.09 | $178.82 |
| Stockton, CA | $1,011.35 | $173.04 |
| Vallejo, CA | $1,192.85 | $184.74 |
| Visalia, CA | $1,011.35 | $173.04 |
| Yuba City, CA | $1,011.35 | $173.04 |
How the 49418 rate is calculated
Each of 49418’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 · 49418
RVUs × geographic indexes × conversion factor
Work3.86
3.86 RVUs× 1.000 GPCI
Practice expense23.83
23.83 RVUs× 1.000 GPCI
Malpractice0.44
0.44 RVUs× 1.000 GPCI
Adjusted RVUs
28.1300
Conversion factor
$33.4009
Medicare rate
$939.57
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49418
The CMS indicators that decide how 49418 is paid alongside other services.
CMS payment indicators · 49418
Peritoneal catheter, percutaneous tunneled placement
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49418 without 51 · national office
$939.57
Peritoneal catheter, percutaneous tunneled placement
49418-51 · Second procedure: 50%
$469.79
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%).
49418 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49419Peritoneal catheterWith subcutaneous port
- Choose 49418 for percutaneous tunneled placement without a port. Choose 49419 when the catheter is placed with a subcutaneous port.
- 49421Dialysis catheter placementOpen, tunneled peritoneal access
- 49421 is for open insertion of a tunneled intraperitoneal catheter for dialysis. This code describes percutaneous placement.
- 49423Drain catheter exchangeFluoroscopic exchange
- 49423 describes exchange of an existing drainage catheter. Use 49418 for initial percutaneous placement of a tunneled intraperitoneal catheter.
- 49422Catheter removalTunneled intraperitoneal
- 49422 is for removal of a tunneled intraperitoneal catheter; 49418 is for placing one.
49418 billing questions
How is this code distinguished from 49419?
49418 describes percutaneous placement of a tunneled intraperitoneal catheter without a port. Use 49419 when the placement includes a subcutaneous port.
Is this the code for an open peritoneal dialysis catheter placement?
No. 49421 describes open insertion of a tunneled intraperitoneal catheter for dialysis; 49418 is for percutaneous placement.
Can catheter imaging or guidance be billed separately?
The submitted facts do not specify separate reporting for imaging or guidance. The record should clearly support the percutaneous catheter placement and its final position.
Can modifier 50 be used for bilateral placement?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports reporting 49418 rather than an exchange code?
Document that a new tunneled catheter was placed percutaneously, including the indication, route, and final position. An exchange of an existing drainage catheter is a different service.
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
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