CPT code 49425: Abdominal shunt, peritoneal-to-venous drainage2026 Medicare rate & RVUs in Maryland
Reports surgical placement of a peritoneovenous shunt to move ascitic fluid from the abdominal cavity into the venous circulation.
CMS doesn’t publish an office rate for 49425 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 49425 covers
This service places a shunt connecting the peritoneal cavity with the venous system, allowing ascitic fluid to flow into the circulation. It is generally performed by a surgeon in a hospital operating room for a patient with ascites when peritoneovenous diversion is selected. The operative record should identify the indication and document creation of the abdominal-to-venous shunt pathway and its placement.
Report 49425 for the shunt insertion itself, not for later revision, evaluation, ligation, or removal. Documentation should distinguish new placement from work on an existing shunt. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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 49425 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 | $795.75 |
| Rest of Maryland | Unavailable | $744.69 |
| Washington, DC area | Unavailable | $823.16 |
How the 49425 rate is calculated
Each of 49425’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 · 49425
RVUs × geographic indexes × conversion factor
Work11.91
11.91 RVUs× 1.000 GPCI
Practice expense7.26
7.26 RVUs× 1.000 GPCI
Malpractice3.18
3.18 RVUs× 1.000 GPCI
Adjusted RVUs
22.3500
Conversion factor
$33.4009
Medicare rate
$746.51
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49425
49425 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49425
Abdominal shunt, peritoneal-to-venous drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49425
Abdominal shunt, peritoneal-to-venous drainage
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49425 without 51 · national facility
$746.51
Abdominal shunt, peritoneal-to-venous drainage
49425-51 · Second procedure: 50%
$373.26
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%).
49425 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49426Shunt revisionAbdominal-to-venous shunt
- 49425 is for placing a new peritoneovenous shunt. Choose 49426 when the operative service revises an existing shunt.
- 49429Shunt removalPeritoneovenous shunt
- 49429 reports removal of an existing abdominal-venous shunt; it does not describe initial shunt placement.
- 49418Peritoneal catheterPercutaneous tunneled placement
- 49418 describes insertion of a tunneled intraperitoneal catheter. It does not create the peritoneal-to-venous shunt reported with 49425.
- 49405Visceral drainagePercutaneous catheter placement
- 49405 describes image-guided catheter drainage of a visceral fluid collection, rather than surgical placement of a peritoneovenous shunt.
49425 billing questions
When should 49425 be chosen instead of 49426?
Use 49425 for placement of a new peritoneovenous shunt. Code 49426 describes revision of an existing abdominal-venous shunt.
Does 49425 cover later shunt removal?
No. The insertion service is distinct from removal of an existing shunt, reported with 49429.
How does 49425 differ from tunneled intraperitoneal catheter placement?
A peritoneovenous shunt routes peritoneal fluid into the venous circulation. Code 49418 is for insertion of a tunneled intraperitoneal catheter, not a peritoneovenous shunt.
What documentation supports reporting 49425?
Document the indication, that a new peritoneovenous shunt was placed, and the operative details establishing the shunt connection. The record should make clear that the service was not revision or removal of an existing shunt.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures in that session are paid at 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.
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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