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CPT code 49418: Peritoneal catheter, percutaneous tunneled placement2026 Medicare rate & RVUs in Puerto Rico

Report this service for initial percutaneous placement of a tunneled catheter into the peritoneal cavity when ongoing access, such as ascites drainage, is needed.

CMS RVU26DEffective Oct 1, 2026One payment locality6.9K Medicare services in 2024

In Puerto Rico, Medicare pays $948.10 for 49418 in the office and $174.81 when it’s performed in a hospital or facility.

$948.10Office (non-facility)
$174.81Hospital or facility
+0.9%vs the national office rate ($939.57)

Check a contract rate as a % of Medicare · 49418 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 49418 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 49418 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 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.

How Puerto Rico compares for 49418

Across 109 of 109 payment localities, the office rate for 49418 runs from $820.21 in Arkansas to $1,298.74 in San Benito County, CA. Puerto Rico pays $948.10. The RVUs are the same everywhere; the geographic indexes change the dollars.

49418 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$948.10
  2. Los Angeles, CA · California$1,085.57+$137.47
  3. Washington, DC area · District of Columbia$1,089.87+$141.77
  4. Miami, FL · Florida$994.67+$46.57
  5. Chicago, IL · Illinois$963.48+$15.38
  6. Manhattan, NY · New York$1,085.37+$137.27
  7. Alaska · Alaska$1,049.17+$101.07

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

Every other payment area

49418 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$833.70$164.43
ArkansasArkansas$820.21$163.18
ArizonaArizona$912.78$171.61
Bakersfield, CACalifornia$1,012.68$174.37
Chico, CACalifornia$1,011.35$173.04
El Centro, CACalifornia$1,011.42$173.11
Fresno, CACalifornia$1,011.35$173.04
Hanford, CACalifornia$1,011.35$173.04

49418 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.

$820.21

$1,155.05

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

View every state and territory as a table
49418 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,049.171
AL$833.701
AR$820.211
AZ$912.781
CA$1,011.35–$1,298.7429
CO$988.841
CT$1,006.521
DC$1,089.871
DE$929.181
FL$911.94–$994.673
GA$856.43–$955.642
GU$1,042.421
HI$1,042.421
IA$863.051
ID$868.151
IL$878.59–$973.314
IN$873.911
KS$855.871
KY$849.971
LA$847.42–$894.612
MA$980.83–$1,097.652
MD$949.20–$1,089.873
ME$870.34–$926.982
MI$872.22–$921.792
MN$952.301
MO$829.35–$901.393
MS$825.101
MT$939.541
NC$880.931
ND$930.841
NE$869.141
NH$970.361
NJ$1,019.38–$1,076.042
NM$876.461
NV$937.911
NY$895.41–$1,110.855
OH$870.441
OK$851.121
OR$932.02–$1,026.222
PA$873.49–$977.362
PR$948.101
RI$966.701
SC$876.871
SD$929.811
TN$860.331
TX$866.89–$984.318
UT$890.311
VA$921.72–$1,089.872
VI$948.101
VT$924.351
WA$979.92–$1,124.002
WI$895.971
WV$841.631
WY$935.751

See 49418 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,799

Code
49418
Physician work
3.86
Practice expense
23.83
Malpractice
0.44

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 49418 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work3.86× 1.0003.8600
Practice expense23.83× 1.01124.0921
Malpractice0.44× 0.9850.4334
Total RVUs28.3855
Conversion factor× 33.4009

Office rate, Puerto Rico$948.10

Office: (3.86 × 1 + 23.83 × 1.011 + 0.44 × 0.985) × $33.4009 = $948.10

Facility: (3.86 × 1 + 0.93 × 1.011 + 0.44 × 0.985) × $33.4009 = $174.81

Open 49418 in the RVU calculator

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

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)0Not paid without supporting documentation.
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

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%).

When to use modifier 51

Codes related to 49418

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

Codes related to 49418
CodeHow it relatesOffice range, Puerto Rico
Same family
49419Peritoneal catheter, with subcutaneous portPercutaneous tunneled intraperitoneal catheter placement with a subcutaneous port.No office rate
Used instead
49421Dialysis catheter placement, open, tunneled peritoneal accessOpen placement of a tunneled intraperitoneal catheter for dialysis.No office rate
49423Drain catheter exchange, fluoroscopic exchangeExchange of an existing drainage catheter rather than initial placement.$554.83

How 49418 has changed in Puerto Rico

49418 · Office / nonfacility

$948.10

Effective 2026-10-01

The base rate is $30.80 higher than on 2025-10-01, moving from $917.30 to $948.10 (3.4%).

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

    $917.30changed to$948.10

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.96 changed to 3.86
    • Practice expense RVU 23.80 changed to 23.83
    • 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

    $968.13changed to$917.30

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 24.53 changed to 23.80
    • Malpractice RVU 0.43 changed to 0.44

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $952.33changed to$968.13

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1015.81changed to$952.33

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 25.39 changed to 24.53
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $1009.16changed to$1015.81

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

  6. January 1, 2023

    RVU23A

    $1063.23changed to$1009.16

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 26.16 changed to 25.39
    • Malpractice RVU 0.40 changed to 0.43
    • 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

    $1182.49changed to$1063.23

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 29.31 changed to 26.16
    • Malpractice RVU 0.39 changed to 0.40

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $1239.44changed to$1182.49

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 29.76 changed to 29.31
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $1309.61changed to$1239.44

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 31.77 changed to 29.76
    • 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

    $1402.06changed to$1309.61

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 34.36 changed to 31.77

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $1206.21changed to$1402.06

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 34.33 changed to 34.36
    • Malpractice RVU 0.41 changed to 0.39
    • 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

    $1070.38changed to$1206.21

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 4.21 changed to 3.96
    • Practice expense RVU 36.25 changed to 34.33
    • Malpractice RVU 0.44 changed to 0.41
    • 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

    $1069.74changed to$1070.38

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 36.06 changed to 36.25
    • Malpractice RVU 0.47 changed to 0.44

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $1064.42changed to$1069.74

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $1042.61changed to$1064.42

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 35.74 changed to 36.06
    • Malpractice RVU 0.60 changed to 0.47
    • 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

    $1055.13changed to$1042.61

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 39.30 changed to 35.74
    • Malpractice RVU 0.63 changed to 0.60
    • 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: $1055.13

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$948.10$174.81RVU26D
2026-07-01$948.10$174.81RVU26C
2026-04-01$948.10$174.81RVU26B
2026-01-01$948.10$174.81RVU26A
2025-10-01$917.30$191.58RVU25D
2025-07-01$917.30$191.58RVU25C
2025-04-01$917.30$191.58RVU25B
2025-01-01$917.30$191.58RVU25A
2024-10-01$968.13$194.81RVU24D
2024-07-01$968.13$194.81RVU24C
2024-04-01$968.13$194.81RVU24B
2024-03-09$968.13$194.81RVU24AR
2024-01-01$952.33$191.63RVU24A
2023-10-01$1,015.81$199.77RVU23D
2023-07-01$1,009.16$199.60RVU23C
2023-04-01$1,009.16$199.60RVU23B
2023-01-01$1,009.16$199.60RVU23A
2022-10-01$1,063.23$202.66RVU22D
2022-07-01$1,063.23$202.66RVU22C
2022-04-01$1,063.23$202.66RVU22B
2022-01-01$1,063.23$202.66RVU22A
2021-10-01$1,182.49$204.35RVU21D
2021-07-01$1,182.49$204.35RVU21C
2021-04-01$1,182.49$204.35RVU21B
2021-01-01$1,182.49$204.35RVU21A
2020-10-01$1,239.44$212.48RVU20D
2020-07-01$1,239.44$212.48RVU20C
2020-04-01$1,239.44$212.48RVU20B
2020-01-01$1,239.44$212.48RVU20A
2019-10-01$1,309.61$212.52RVU19D
2019-07-01$1,309.61$212.52RVU19C
2019-04-01$1,309.61$212.52RVU19B
2019-01-01$1,309.61$212.52RVU19A
2018-10-01$1,402.06$212.65RVU18D
2018-07-01$1,402.06$212.65RVU18C
2018-04-01$1,402.06$212.65RVU18B
2018-01-01$1,402.06$212.65RVU18AR1
2017-10-01$1,206.21$200.10RVU17D
2017-07-01$1,206.21$200.10RVU17C
2017-04-01$1,206.21$200.10RVU17B
2017-01-01$1,206.21$200.10RVU17A
2016-10-01$1,070.38$198.01RVU16D
2016-07-01$1,070.38$198.01RVU16C
2016-04-01$1,070.38$198.01RVU16B
2016-01-01$1,070.38$198.01RVU16A
2015-10-01$1,069.74$198.79RVU15D
2015-07-01$1,069.74$198.79RVU15C
2015-04-01$1,064.42$197.80RVU15B
2015-01-01$1,064.42$197.80RVU15A
2014-10-01$1,042.61$199.03RVU14D
2014-07-01$1,042.61$199.03RVU14C
2014-04-01$1,042.61$199.03RVU14B
2014-01-01$1,042.61$199.03RVU14A
2013-10-01$1,055.13$189.87RVU13D
2013-07-01$1,055.13$189.87RVU13C
2013-04-01$1,055.13$189.87RVU13B
2013-01-01$1,055.13$189.87RVU13AR

Price 49418 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

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

Show the CMS file lines behind this rate
RVUs for 49418PPRRVU2026_Oct_nonQPP.csv, line 5,799 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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