CPT code 49422: Catheter removal, tunneled intraperitoneal2026 Medicare rate & RVUs in Puerto Rico
Removal of a tunneled catheter from the peritoneal cavity, commonly for peritoneal dialysis patients with infection, malfunction, or no further need for access.
In Puerto Rico, Medicare pays $201.69 for 49422 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 49422 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 49422 covers
This code covers removal of a tunneled catheter that enters the peritoneal cavity, including a peritoneal dialysis catheter. A surgeon or other qualified physician may perform the procedure in an operating room or another procedural setting, such as when catheter-related infection or malfunction requires removal, or when the patient no longer needs peritoneal access. The service is removal of the existing catheter, not placement of a replacement device.
Report the code when the tunneled intraperitoneal catheter is actually removed. The operative note should identify the catheter and document its removal; include the clinical reason when available. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment is statutorily restricted, and co-surgeon and team-surgery payment 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 49422
Across 109 of 109 payment localities, the facility rate for 49422 runs from $177.90 in Wisconsin to $255.04 in Alaska. Puerto Rico pays $201.69. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$201.69
- Los Angeles, CA · California$203.52+$1.83
- Washington, DC area · District of Columbia$219.41+$17.72
- Miami, FL · Florida$252.38+$50.69
- Chicago, IL · Illinois$244.37+$42.68
- Manhattan, NY · New York$235.25+$33.56
- Alaska · Alaska$255.04+$53.35
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $182.90 |
| ArkansasArkansas | — | $180.63 |
| ArizonaArizona | — | $195.90 |
| Bakersfield, CACalifornia | — | $195.46 |
| Chico, CACalifornia | — | $192.86 |
| El Centro, CACalifornia | — | $193.02 |
| Fresno, CACalifornia | — | $192.86 |
| Hanford, CACalifornia | — | $192.86 |
| Madera, CACalifornia | — | $192.86 |
| Merced, CACalifornia | — | $192.86 |
| Modesto, CACalifornia | — | $192.86 |
| Napa, CACalifornia | — | $206.71 |
| Oxnard, CACalifornia | — | $200.47 |
| Redding, CACalifornia | — | $192.86 |
| Rest of CaliforniaCalifornia | — | $192.86 |
| Riverside, CACalifornia | — | $203.16 |
| Sacramento, CACalifornia | — | $197.98 |
| Salinas, CACalifornia | — | $197.17 |
| San Diego, CACalifornia | — | $198.69 |
| Marin County, CACalifornia | — | $212.93 |
| San Francisco, CACalifornia | — | $211.84 |
| San Benito County, CACalifornia | — | $218.61 |
| Santa Clara County, CACalifornia | — | $214.16 |
| San Luis Obispo, CACalifornia | — | $194.56 |
| Santa Cruz, CACalifornia | — | $198.07 |
| Santa Maria, CACalifornia | — | $197.05 |
| Santa Rosa, CACalifornia | — | $199.76 |
| Stockton, CACalifornia | — | $192.86 |
| Vallejo, CACalifornia | — | $205.13 |
| Visalia, CACalifornia | — | $192.86 |
| Yuba City, CACalifornia | — | $192.86 |
| ColoradoColorado | — | $198.80 |
| ConnecticutConnecticut | — | $214.12 |
| DelawareDelaware | — | $198.68 |
| Fort Lauderdale, FLFlorida | — | $228.16 |
| Rest of FloridaFlorida | — | $216.14 |
| Atlanta, GAGeorgia | — | $209.21 |
| Rest of GeorgiaGeorgia | — | $203.64 |
| Hawaii, Guam, HIHawaii | — | $193.64 |
| IowaIowa | — | $179.06 |
| IdahoIdaho | — | $181.69 |
| East St. Louis, ILIllinois | — | $231.10 |
| Rest of IllinoisIllinois | — | $216.37 |
| Suburban Chicago, ILIllinois | — | $228.47 |
| IndianaIndiana | — | $182.38 |
| KansasKansas | — | $182.05 |
| KentuckyKentucky | — | $194.64 |
| New Orleans, LALouisiana | — | $203.78 |
| Rest of LouisianaLouisiana | — | $195.86 |
| Metropolitan Boston, MAMassachusetts | — | $211.20 |
| Rest of MassachusettsMassachusetts | — | $199.41 |
| Baltimore area, MDMaryland | — | $214.30 |
| Rest of MarylandMaryland | — | $200.89 |
| Rest of MaineMaine | — | $186.47 |
| Southern Maine, MEMaine | — | $189.55 |
| Detroit, MIMichigan | — | $222.36 |
| Rest of MichiganMichigan | — | $202.45 |
| MinnesotaMinnesota | — | $180.31 |
| Metropolitan Kansas City, MOMissouri | — | $198.60 |
| Metropolitan St. Louis, MOMissouri | — | $199.91 |
| Rest of MissouriMissouri | — | $195.47 |
| MississippiMississippi | — | $187.89 |
| MontanaMontana | — | $201.68 |
| North CarolinaNorth Carolina | — | $187.53 |
| North DakotaNorth Dakota | — | $182.69 |
| NebraskaNebraska | — | $178.76 |
| New HampshireNew Hampshire | — | $199.35 |
| Northern New JerseyNew Jersey | — | $218.43 |
| Rest of New JerseyNew Jersey | — | $213.69 |
| New MexicoNew Mexico | — | $204.92 |
| NevadaNevada | — | $196.43 |
| NYC suburbs and Long Island, NYNew York | — | $245.01 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $218.08 |
| Queens, NYNew York | — | $231.42 |
| Rest of New YorkNew York | — | $190.25 |
| OhioOhio | — | $198.57 |
| OklahomaOklahoma | — | $190.37 |
| Portland, OROregon | — | $199.99 |
| Rest of OregonOregon | — | $192.06 |
| Metropolitan Philadelphia, PAPennsylvania | — | $211.89 |
| Rest of PennsylvaniaPennsylvania | — | $196.75 |
| Rhode IslandRhode Island | — | $202.05 |
| South CarolinaSouth Carolina | — | $193.94 |
| South DakotaSouth Dakota | — | $180.45 |
| TennesseeTennessee | — | $183.31 |
| Austin, TXTexas | — | $200.63 |
| Beaumont, TXTexas | — | $195.92 |
| Brazoria, TXTexas | — | $195.37 |
| Dallas, TXTexas | — | $198.20 |
| Fort Worth, TXTexas | — | $198.23 |
| Galveston, TXTexas | — | $196.99 |
| Houston, TXTexas | — | $214.56 |
| Rest of TexasTexas | — | $196.62 |
| UtahUtah | — | $196.11 |
| VirginiaVirginia | — | $191.64 |
| Virgin Islands, VIUnited States Virgin Islands | — | $201.69 |
| VermontVermont | — | $185.51 |
| Rest of WashingtonWashington | — | $197.86 |
| King County, WAWashington | — | $211.33 |
| WisconsinWisconsin | — | $177.90 |
| West VirginiaWest Virginia | — | $210.40 |
| WyomingWyoming | — | $193.40 |
49422 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 49422 rate is calculated
Each of 49422’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 · 49422
RVUs × geographic indexes × conversion factor
Work3.90
3.90 RVUs× 1.000 GPCI
Practice expense1.18
1.18 RVUs× 1.000 GPCI
Malpractice0.96
0.96 RVUs× 1.000 GPCI
Adjusted RVUs
6.0400
Conversion factor
$33.4009
Medicare rate
$201.74
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
5,802
- Code
- 49422
- Physician work
- 3.90
- Practice expense
- 1.18
- Malpractice
- 0.96
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.90 | × 1.000 | 3.9000 |
| Practice expense | 1.18 | × 1.011 | 1.1930 |
| Malpractice | 0.96 | × 0.985 | 0.9456 |
| Total RVUs | 6.0386 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Puerto Rico$201.69
Facility: (3.9 × 1 + 1.18 × 1.011 + 0.96 × 0.985) × $33.4009 = $201.69
Payment rules and modifiers for 49422
The CMS indicators that decide how 49422 is paid alongside other services.
CMS payment indicators · 49422
Catheter removal, tunneled intraperitoneal
| 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
49422 without 51 · national facility
$201.74
Catheter removal, tunneled intraperitoneal
49422-51 · Second procedure: 50%
$100.87
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%).
How 49422 has changed in Puerto Rico
49422 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $201.69 | RVU26D |
| 2026-07-01 | Not available in this setting | $201.69 | RVU26C |
| 2026-04-01 | Not available in this setting | $201.69 | RVU26B |
| 2026-01-01 | Not available in this setting | $201.69 | RVU26A |
| 2025-10-01 | Not available in this setting | $213.01 | RVU25D |
| 2025-07-01 | Not available in this setting | $213.01 | RVU25C |
| 2025-04-01 | Not available in this setting | $213.01 | RVU25B |
| 2025-01-01 | Not available in this setting | $213.01 | RVU25A |
| 2024-10-01 | Not available in this setting | $218.84 | RVU24D |
| 2024-07-01 | Not available in this setting | $218.84 | RVU24C |
| 2024-04-01 | Not available in this setting | $218.84 | RVU24B |
| 2024-03-09 | Not available in this setting | $218.84 | RVU24AR |
| 2024-01-01 | Not available in this setting | $215.27 | RVU24A |
| 2023-10-01 | Not available in this setting | $221.91 | RVU23D |
| 2023-07-01 | Not available in this setting | $221.96 | RVU23C |
| 2023-04-01 | Not available in this setting | $221.96 | RVU23B |
| 2023-01-01 | Not available in this setting | $221.96 | RVU23A |
| 2022-10-01 | Not available in this setting | $227.36 | RVU22D |
| 2022-07-01 | Not available in this setting | $227.36 | RVU22C |
| 2022-04-01 | Not available in this setting | $227.36 | RVU22B |
| 2022-01-01 | Not available in this setting | $227.36 | RVU22A |
| 2021-10-01 | Not available in this setting | $227.86 | RVU21D |
| 2021-07-01 | Not available in this setting | $227.86 | RVU21C |
| 2021-04-01 | Not available in this setting | $227.86 | RVU21B |
| 2021-01-01 | Not available in this setting | $227.86 | RVU21A |
| 2020-10-01 | Not available in this setting | $233.21 | RVU20D |
| 2020-07-01 | Not available in this setting | $233.21 | RVU20C |
| 2020-04-01 | Not available in this setting | $233.21 | RVU20B |
| 2020-01-01 | Not available in this setting | $233.21 | RVU20A |
| 2019-10-01 | Not available in this setting | $232.89 | RVU19D |
| 2019-07-01 | Not available in this setting | $232.89 | RVU19C |
| 2019-04-01 | Not available in this setting | $232.89 | RVU19B |
| 2019-01-01 | Not available in this setting | $232.89 | RVU19A |
| 2018-10-01 | Not available in this setting | $395.96 | RVU18D |
| 2018-07-01 | Not available in this setting | $395.96 | RVU18C |
| 2018-04-01 | Not available in this setting | $395.96 | RVU18B |
| 2018-01-01 | Not available in this setting | $395.96 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $359.61 | RVU17D |
| 2017-07-01 | Not available in this setting | $359.61 | RVU17C |
| 2017-04-01 | Not available in this setting | $359.61 | RVU17B |
| 2017-01-01 | Not available in this setting | $359.61 | RVU17A |
| 2016-10-01 | Not available in this setting | $323.91 | RVU16D |
| 2016-07-01 | Not available in this setting | $323.91 | RVU16C |
| 2016-04-01 | Not available in this setting | $323.91 | RVU16B |
| 2016-01-01 | Not available in this setting | $323.91 | RVU16A |
| 2015-10-01 | Not available in this setting | $324.26 | RVU15D |
| 2015-07-01 | Not available in this setting | $324.26 | RVU15C |
| 2015-04-01 | Not available in this setting | $322.64 | RVU15B |
| 2015-01-01 | Not available in this setting | $322.64 | RVU15A |
| 2014-10-01 | Not available in this setting | $320.06 | RVU14D |
| 2014-07-01 | Not available in this setting | $320.06 | RVU14C |
| 2014-04-01 | Not available in this setting | $320.06 | RVU14B |
| 2014-01-01 | Not available in this setting | $320.06 | RVU14A |
| 2013-10-01 | Not available in this setting | $311.21 | RVU13D |
| 2013-07-01 | Not available in this setting | $311.21 | RVU13C |
| 2013-04-01 | Not available in this setting | $311.21 | RVU13B |
| 2013-01-01 | Not available in this setting | $311.21 | RVU13AR |
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
49422 billing questions
How does 49422 differ from 49421?
49422 is for removing an existing tunneled intraperitoneal catheter. 49421 describes open placement of a tunneled intraperitoneal catheter for dialysis.
Can catheter insertion be reported during the same session?
When a new catheter is placed during the same session as removal, the insertion service may be reported separately when performed and documented. For example, 49421 describes open placement for dialysis.
Should modifier 50 be used for removal of two catheters?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 does not describe the service.
What global period applies?
The procedure has a 0-day global period. Same-day preoperative and postoperative care is included.
Can an assistant or co-surgeon be paid for this procedure?
Assistant-at-surgery payment is subject to a statutory restriction. CMS also identifies co-surgeon and team-surgery payment as 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
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