CPT code 49428: Shunt ligation, peritoneovenous shunt2026 Medicare rate & RVUs

Medicare pays $411.50 for 49428 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 49428 covers

This procedure closes a peritoneovenous shunt that carries fluid from the peritoneal cavity into the venous system. A surgeon performs it to stop shunt flow, such as when the device is no longer intended to function. It is distinct from revising a shunt that will remain in use or removing the device itself. The service is generally performed in a surgical setting.

Report 49428 when the operative work is ligation, rather than shunt revision or removal. The operative note should identify the peritoneovenous shunt and document that it was surgically closed. Medicare includes related postoperative visits during the 10-day global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Do not append modifier 50; the shunt anatomy and descriptor are not billed as bilateral. Medicare does not pay an assistant-at-surgery claim under the statutory restriction, and co-surgeon and team-surgery billing 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 49428 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

49428 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 49428 rate is calculated

Each of 49428’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.

Payment rules and modifiers for 49428

49428 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

49428 compared with similar codes

How to choose

49426Shunt revisionAbdominal-to-venous shunt

Choose 49426 when the shunt is revised and remains in use. Choose 49428 when the operation closes the shunt to stop flow.

49427Shunt injectionPeritoneovenous shunt assessment

49427 describes injection of an abdominal venous shunt, not its surgical closure.

49429Shunt removalPeritoneovenous shunt

49429 is for removing the shunt; 49428 closes it by ligation while leaving it in place.

49425Abdominal shuntPeritoneal-to-venous drainage

49425 is for placing an abdominal venous shunt, whereas 49428 closes an existing peritoneovenous shunt.

Codes related to 49428

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

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

Open CMS sourceHow we calculate rates