CPT code 49421: Dialysis catheter placement, open, tunneled peritoneal access2026 Medicare rate & RVUs in Maryland
Report this service when a surgeon uses an open approach to place a tunneled catheter into the abdomen for peritoneal dialysis.
CMS doesn’t publish an office rate for 49421 in Maryland.
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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What 49421 covers
This procedure establishes access for peritoneal dialysis, often for a patient preparing to begin home dialysis. A surgeon makes an incision to place the catheter into the peritoneal cavity and routes part of it through a tunnel beneath the skin. The procedure is commonly performed in an operating room. The open approach, rather than the need for dialysis alone, distinguishes this service from percutaneous catheter placement.
Report 49421 when the operative note supports open insertion, intraperitoneal catheter placement, and creation of the subcutaneous tunnel. A catheter placed percutaneously or one connected to an implanted subcutaneous port calls for a different code. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. CMS does not pay an assistant at surgery for this code and does not permit co-surgeons or team surgery.
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 49421 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $219.68 |
| Rest of Maryland | Unavailable | $205.72 |
| Washington, DC area | Unavailable | $224.34 |
How the 49421 rate is calculated
Each of 49421’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 · 49421
RVUs × geographic indexes × conversion factor
Work4.10
4.10 RVUs× 1.000 GPCI
Practice expense1.06
1.06 RVUs× 1.000 GPCI
Malpractice1.03
1.03 RVUs× 1.000 GPCI
Adjusted RVUs
6.1900
Conversion factor
$33.4009
Medicare rate
$206.75
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49421
The CMS indicators that decide how 49421 is paid alongside other services.
CMS payment indicators · 49421
Dialysis catheter placement, open, tunneled peritoneal access
| 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) | 1 | Not paid (statutory restriction). |
| 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
49421 without 51 · national facility
$206.75
Dialysis catheter placement, open, tunneled peritoneal access
49421-51 · Second procedure: 50%
$103.38
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%).
49421 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49418Peritoneal catheterPercutaneous tunneled placement
- Both establish tunneled intraperitoneal catheter access. Choose 49421 for open surgical insertion and 49418 for percutaneous insertion.
- 49419Peritoneal catheterWith subcutaneous port
- Choose 49419 when placement includes an implanted subcutaneous port. A catheter tunneled beneath the skin without a port is not enough to select 49419.
- 49435Catheter extensionSubcutaneous extension
- 49421 covers open placement of the tunneled intraperitoneal catheter, including its tunnel. Code 49435 addresses insertion of a separate subcutaneous extension, not routine tunneling.
49421 billing questions
How is 49421 distinguished from 49418?
Use 49421 when the surgeon places the tunneled intraperitoneal dialysis catheter through an open incision. Code 49418 describes percutaneous insertion.
What if the catheter has an implanted subcutaneous port?
Consider 49419 for insertion of a tunneled intraperitoneal catheter with a subcutaneous port. Documenting a subcutaneous tunnel alone does not establish that a port was implanted.
Is routine care before and after placement separately reported on the procedure date?
The 0-day global period includes same-day preoperative and postoperative care for the open catheter placement.
How does Medicare pay 49421 with another procedure in the same session?
The standard multiple procedure reduction applies: the highest-valued procedure is paid in full and the others at 50%.
Can modifier 50 or a surgical assistant be reported for 49421?
Modifier 50 is inappropriate for this catheter placement. CMS does not pay an assistant at surgery for 49421 and does not permit co-surgeons or team surgery.
Is the subcutaneous tunnel itself reported with 49435?
No. Tunneling is part of the placement described by 49421; 49435 concerns a separately inserted subcutaneous catheter extension.
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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