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

Ligation of a peritoneovenous shunt permanently closes the channel carrying ascitic fluid into venous circulation when the shunt is taken out of service.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Delaware, Medicare pays $405.07 for 49428 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$405.07Hospital or facility

Check a contract rate as a % of Medicare · 49428 nationwide

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

We’ll open 49428 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Delaware
  2. What 49428 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Delaware compares for 49428

Across 109 of 109 payment localities, the facility rate for 49428 runs from $364.58 in Arkansas to $507.66 in Miami, FL. Delaware pays $405.07. The RVUs are the same everywhere; the geographic indexes change the dollars.

49428 in Delaware vs other payment areas
  1. Delaware · this page$405.07
  2. Los Angeles, CA · California$424.17+$19.10
  3. Washington, DC area · District of Columbia$453.13+$48.06
  4. Miami, FL · Florida$507.66+$102.59
  5. Chicago, IL · Illinois$490.70+$85.63
  6. Manhattan, NY · New York$481.44+$76.37
  7. Alaska · Alaska$505.03+$99.96

Other areas in Delaware first, then benchmark localities. Bars start at $0.

Every other payment area

49428 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama—$369.66
ArkansasArkansas—$364.58
ArizonaArizona—$398.96
Bakersfield, CACalifornia—$404.82
Chico, CACalifornia—$400.03
El Centro, CACalifornia—$400.33
Fresno, CACalifornia—$400.03
Hanford, CACalifornia—$400.03

49428 rates by state

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

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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
49428 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

See 49428 in every payment locality

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.

How the rate is built · 49428

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.70

6.70 RVUs× 1.000 GPCI

Practice expense3.84

3.84 RVUs× 1.000 GPCI

Malpractice1.78

1.78 RVUs× 1.000 GPCI

Adjusted RVUs

12.3200

Conversion factor

$33.4009

Medicare rate

$411.50

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Delaware inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,808

Code
49428
Physician work
6.70
Practice expense
3.84
Malpractice
1.78

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Facility calculation for 49428 in Delaware
ComponentRVULocality factorAdjusted
Physician work6.70× 1.0056.7335
Practice expense3.84× 0.9883.7939
Malpractice1.78× 0.8991.6002
Total RVUs12.1276
Conversion factor× 33.4009

Facility rate, Delaware$405.07

Facility: (6.7 × 1.005 + 3.84 × 0.988 + 1.78 × 0.899) × $33.4009 = $405.07

Open 49428 in the RVU calculator

Payment rules and modifiers for 49428

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

CMS payment indicators · 49428

Shunt ligation, peritoneovenous shunt

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 49428

Shunt ligation, peritoneovenous shunt

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

49428 without 51 · national facility

$411.50

Shunt ligation, peritoneovenous shunt

49428-51 · Second procedure: 50%

$205.75

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%).

When to use modifier 51

How 49428 has changed in Delaware

49428 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

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
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$405.07RVU26D
2026-07-01Not available in this setting$405.07RVU26C
2026-04-01Not available in this setting$405.07RVU26B
2026-01-01Not available in this setting$405.07RVU26A
2025-10-01Not available in this setting$420.09RVU25D
2025-07-01Not available in this setting$420.09RVU25C
2025-04-01Not available in this setting$420.09RVU25B
2025-01-01Not available in this setting$420.09RVU25A
2024-10-01Not available in this setting$429.65RVU24D
2024-07-01Not available in this setting$429.65RVU24C
2024-04-01Not available in this setting$429.65RVU24B
2024-03-09Not available in this setting$429.65RVU24AR
2024-01-01Not available in this setting$422.64RVU24A
2023-10-01Not available in this setting$436.18RVU23D
2023-07-01Not available in this setting$436.18RVU23C
2023-04-01Not available in this setting$436.18RVU23B
2023-01-01Not available in this setting$436.18RVU23A
2022-10-01Not available in this setting$445.48RVU22D
2022-07-01Not available in this setting$445.48RVU22C
2022-04-01Not available in this setting$445.48RVU22B
2022-01-01Not available in this setting$445.48RVU22A
2021-10-01Not available in this setting$445.78RVU21D
2021-07-01Not available in this setting$445.78RVU21C
2021-04-01Not available in this setting$445.78RVU21B
2021-01-01Not available in this setting$445.78RVU21A
2020-10-01Not available in this setting$459.94RVU20D
2020-07-01Not available in this setting$459.94RVU20C
2020-04-01Not available in this setting$459.94RVU20B
2020-01-01Not available in this setting$459.94RVU20A
2019-10-01Not available in this setting$462.43RVU19D
2019-07-01Not available in this setting$462.43RVU19C
2019-04-01Not available in this setting$462.43RVU19B
2019-01-01Not available in this setting$462.43RVU19A
2018-10-01Not available in this setting$461.88RVU18D
2018-07-01Not available in this setting$461.88RVU18C
2018-04-01Not available in this setting$461.88RVU18B
2018-01-01Not available in this setting$461.88RVU18AR1
2017-10-01Not available in this setting$490.83RVU17D
2017-07-01Not available in this setting$490.83RVU17C
2017-04-01Not available in this setting$490.83RVU17B
2017-01-01Not available in this setting$490.83RVU17A
2016-10-01Not available in this setting$460.21RVU16D
2016-07-01Not available in this setting$460.21RVU16C
2016-04-01Not available in this setting$460.21RVU16B
2016-01-01Not available in this setting$460.21RVU16A
2015-10-01Not available in this setting$573.19RVU15D
2015-07-01Not available in this setting$573.19RVU15C
2015-04-01Not available in this setting$570.33RVU15B
2015-01-01Not available in this setting$570.33RVU15A
2014-10-01Not available in this setting$442.14RVU14D
2014-07-01Not available in this setting$442.14RVU14C
2014-04-01Not available in this setting$442.14RVU14B
2014-01-01Not available in this setting$442.14RVU14A
2013-10-01Not available in this setting$428.57RVU13D
2013-07-01Not available in this setting$428.57RVU13C
2013-04-01Not available in this setting$428.57RVU13B
2013-01-01Not available in this setting$428.57RVU13AR

Price 49428 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

49428 billing questions

How is ligation different from shunt removal?

49428 is for surgically closing the shunt while it remains in place. Report 49429 when the shunt is removed.

When should 49428 be chosen over shunt revision?

Use 49428 when the operative intent is to stop shunt flow by ligating it. Use 49426 when the shunt is revised rather than taken out of service.

What should the operative note document?

Document that the device is a peritoneovenous shunt and that the surgeon ligated it to stop flow. The note should make clear whether the shunt was closed, revised, or removed.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard multiple-procedure reduction.

Can modifier 50 or an assistant-at-surgery claim be used?

Modifier 50 is inappropriate for this shunt procedure. Medicare does not pay an assistant-at-surgery claim; 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
RVUs for 49428PPRRVU2026_Oct_nonQPP.csv, line 5,808 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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