CPT code 49427: Shunt injection, peritoneovenous shunt assessment2026 Medicare rate & RVUs in Texas
Reports injection of an existing peritoneovenous shunt to evaluate its function, commonly when a patient with ascites has suspected shunt obstruction or malfunction.
CMS doesn’t publish an office rate for 49427 in Texas.
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 49427 covers
This service evaluates an existing peritoneovenous shunt, such as a LeVeen shunt, by injecting contrast into the shunt and assessing its flow. It may be performed by an interventional radiologist or surgeon for a patient with ascites when clinical findings raise concern about shunt patency or function. The procedure is distinct from placing, revising, ligating, or removing the shunt.
Report 49427 for the injection and assessment, supported by documentation identifying the shunt, the reason for evaluation, the access and injection performed, and the findings. The CMS global period is 0 days, 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. Bilateral adjustment is inappropriate for this service. Assistant-at-surgery payment requires documentation of medical necessity; 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 49427 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $35.20 |
| Beaumont, TX | Unavailable | $34.90 |
| Brazoria, TX | Unavailable | $34.81 |
| Dallas, TX | Unavailable | $35.13 |
| Fort Worth, TX | Unavailable | $35.16 |
| Galveston, TX | Unavailable | $34.99 |
| Houston, TX | Unavailable | $37.00 |
| Rest of Texas | Unavailable | $34.91 |
How the 49427 rate is calculated
Each of 49427’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 · 49427
RVUs × geographic indexes × conversion factor
Work0.87
0.87 RVUs× 1.000 GPCI
Practice expense0.08
0.08 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
1.0600
Conversion factor
$33.4009
Medicare rate
$35.40
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49427
The CMS indicators that decide how 49427 is paid alongside other services.
CMS payment indicators · 49427
Shunt injection, peritoneovenous shunt assessment
| 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
49427 without 51 · national facility
$35.40
Shunt injection, peritoneovenous shunt assessment
49427-51 · Second procedure: 50%
$17.70
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%).
49427 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49425Abdominal shuntPeritoneal-to-venous drainage
- Choose 49425 when inserting a new peritoneovenous shunt. Choose 49427 when injecting and assessing a shunt that is already present.
- 49426Shunt revisionAbdominal-to-venous shunt
- Choose 49426 for operative revision of the shunt. Choose 49427 for injection and evaluation without shunt revision.
- 49428Shunt ligationPeritoneovenous shunt
- 49428 describes ligating the shunt; 49427 describes injecting it to assess function.
- 49429Shunt removalPeritoneovenous shunt
- 49429 describes shunt removal. It is not the code for injection and assessment of a shunt that remains in place.
49427 billing questions
When should 49427 be selected instead of 49426?
Use 49427 for injection and assessment of an existing shunt. Use 49426 when the shunt itself is revised.
Is 49427 used to place a new peritoneovenous shunt?
No. Placement is reported with 49425; 49427 describes injection and assessment of an existing shunt.
Can 49427 be reported with shunt revision during the same session?
If injection and assessment are performed along with a revision, document the distinct work and follow applicable coding edits. CMS applies the standard multiple procedure reduction when multiple procedures are performed in the same session.
Does 49427 have a global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
Can modifier 50 be used for 49427?
No. Bilateral adjustment is inappropriate for this service.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are 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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