CPT code 49428: Shunt ligation, peritoneovenous shunt2026 Medicare rate & RVUs in Nevada
Ligation of a peritoneovenous shunt permanently closes the channel carrying ascitic fluid into venous circulation when the shunt is taken out of service.
In Nevada, Medicare pays $401.70 for 49428 in a facility. There’s no office rate.
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.
On this page 11 sections
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 Nevada 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. Nevada pays $401.70. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Nevada · this page$401.70
- Los Angeles, CA · California$424.17+$22.47
- Washington, DC area · District of Columbia$453.13+$51.43
- Miami, FL · Florida$507.66+$105.96
- Chicago, IL · Illinois$490.70+$89.00
- Manhattan, NY · New York$481.44+$79.74
- Alaska · Alaska$505.03+$103.33
Other areas in Nevada first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | — | $400.03 |
| Merced, CACalifornia | — | $400.03 |
| Modesto, CACalifornia | — | $400.03 |
| Napa, CACalifornia | — | $437.13 |
| Oxnard, CACalifornia | — | $418.69 |
| Redding, CACalifornia | — | $400.03 |
| Rest of CaliforniaCalifornia | — | $400.03 |
| Riverside, CACalifornia | — | $419.10 |
| Sacramento, CACalifornia | — | $412.88 |
| Salinas, CACalifornia | — | $411.24 |
| San Diego, CACalifornia | — | $416.12 |
| Marin County, CACalifornia | — | $453.18 |
| San Francisco, CACalifornia | — | $451.16 |
| San Benito County, CACalifornia | — | $465.22 |
| Santa Clara County, CACalifornia | — | $456.96 |
| San Luis Obispo, CACalifornia | — | $405.55 |
| Santa Cruz, CACalifornia | — | $416.19 |
| Santa Maria, CACalifornia | — | $411.47 |
| Santa Rosa, CACalifornia | — | $419.87 |
| Stockton, CACalifornia | — | $400.03 |
| Vallejo, CACalifornia | — | $434.22 |
| Visalia, CACalifornia | — | $400.03 |
| Yuba City, CACalifornia | — | $400.03 |
| ColoradoColorado | — | $409.37 |
| ConnecticutConnecticut | — | $438.34 |
| DelawareDelaware | — | $405.07 |
| Fort Lauderdale, FLFlorida | — | $461.20 |
| Rest of FloridaFlorida | — | $435.76 |
| Atlanta, GAGeorgia | — | $426.17 |
| Rest of GeorgiaGeorgia | — | $409.06 |
| Hawaii, Guam, HIHawaii | — | $404.04 |
| IowaIowa | — | $364.75 |
| IdahoIdaho | — | $369.91 |
| East St. Louis, ILIllinois | — | $461.52 |
| Rest of IllinoisIllinois | — | $433.81 |
| Suburban Chicago, ILIllinois | — | $462.43 |
| IndianaIndiana | — | $371.58 |
| KansasKansas | — | $369.70 |
| KentuckyKentucky | — | $392.21 |
| New Orleans, LALouisiana | — | $412.02 |
| Rest of LouisianaLouisiana | — | $394.25 |
| Metropolitan Boston, MAMassachusetts | — | $439.02 |
| Rest of MassachusettsMassachusetts | — | $409.81 |
| Baltimore area, MDMaryland | — | $438.53 |
| Rest of MarylandMaryland | — | $410.40 |
| Rest of MaineMaine | — | $378.76 |
| Southern Maine, MEMaine | — | $388.41 |
| Detroit, MIMichigan | — | $447.80 |
| Rest of MichiganMichigan | — | $408.01 |
| MinnesotaMinnesota | — | $373.36 |
| Metropolitan Kansas City, MOMissouri | — | $402.31 |
| Metropolitan St. Louis, MOMissouri | — | $405.46 |
| Rest of MissouriMissouri | — | $392.25 |
| MississippiMississippi | — | $378.15 |
| MontanaMontana | — | $411.38 |
| North CarolinaNorth Carolina | — | $381.44 |
| North DakotaNorth Dakota | — | $376.18 |
| NebraskaNebraska | — | $364.64 |
| New HampshireNew Hampshire | — | $409.33 |
| Northern New JerseyNew Jersey | — | $450.16 |
| Rest of New JerseyNew Jersey | — | $438.02 |
| New MexicoNew Mexico | — | $412.80 |
| NYC suburbs and Long Island, NYNew York | — | $501.01 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $446.24 |
| Queens, NYNew York | — | $475.44 |
| Rest of New YorkNew York | — | $387.43 |
| OhioOhio | — | $400.82 |
| OklahomaOklahoma | — | $384.52 |
| Portland, OROregon | — | $414.10 |
| Rest of OregonOregon | — | $393.33 |
| Metropolitan Philadelphia, PAPennsylvania | — | $432.26 |
| Rest of PennsylvaniaPennsylvania | — | $397.71 |
| Puerto RicoPuerto Rico | — | $412.02 |
| Rhode IslandRhode Island | — | $413.56 |
| South CarolinaSouth Carolina | — | $392.83 |
| South DakotaSouth Dakota | — | $372.02 |
| TennesseeTennessee | — | $372.30 |
| Austin, TXTexas | — | $412.61 |
| Beaumont, TXTexas | — | $395.73 |
| Brazoria, TXTexas | — | $399.06 |
| Dallas, TXTexas | — | $404.56 |
| Fort Worth, TXTexas | — | $404.05 |
| Galveston, TXTexas | — | $402.17 |
| Houston, TXTexas | — | $434.75 |
| Rest of TexasTexas | — | $399.19 |
| UtahUtah | — | $397.74 |
| VirginiaVirginia | — | $391.84 |
| Virgin Islands, VIUnited States Virgin Islands | — | $412.02 |
| VermontVermont | — | $380.85 |
| Rest of WashingtonWashington | — | $407.00 |
| King County, WAWashington | — | $440.92 |
| WisconsinWisconsin | — | $364.97 |
| West VirginiaWest Virginia | — | $420.32 |
| WyomingWyoming | — | $396.04 |
49428 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 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
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 Nevada 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
73
- Locality
- Nevada
- Physician work
- 1.000
- Practice expense
- 1.001
- Malpractice
- 0.833
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.70 | × 1.000 | 6.7000 |
| Practice expense | 3.84 | × 1.001 | 3.8438 |
| Malpractice | 1.78 | × 0.833 | 1.4827 |
| Total RVUs | 12.0266 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nevada$401.70
Facility: (6.7 × 1 + 3.84 × 1.001 + 1.78 × 0.833) × $33.4009 = $401.70
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 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. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share 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.
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%).
How 49428 has changed in Nevada
49428 · 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 | $401.70 | RVU26D |
| 2026-07-01 | Not available in this setting | $401.70 | RVU26C |
| 2026-04-01 | Not available in this setting | $401.70 | RVU26B |
| 2026-01-01 | Not available in this setting | $401.70 | RVU26A |
| 2025-10-01 | Not available in this setting | $413.29 | RVU25D |
| 2025-07-01 | Not available in this setting | $413.29 | RVU25C |
| 2025-04-01 | Not available in this setting | $413.29 | RVU25B |
| 2025-01-01 | Not available in this setting | $413.29 | RVU25A |
| 2024-10-01 | Not available in this setting | $422.60 | RVU24D |
| 2024-07-01 | Not available in this setting | $422.60 | RVU24C |
| 2024-04-01 | Not available in this setting | $422.60 | RVU24B |
| 2024-03-09 | Not available in this setting | $422.60 | RVU24AR |
| 2024-01-01 | Not available in this setting | $415.70 | RVU24A |
| 2023-10-01 | Not available in this setting | $442.86 | RVU23D |
| 2023-07-01 | Not available in this setting | $442.86 | RVU23C |
| 2023-04-01 | Not available in this setting | $442.86 | RVU23B |
| 2023-01-01 | Not available in this setting | $442.86 | RVU23A |
| 2022-10-01 | Not available in this setting | $467.46 | RVU22D |
| 2022-07-01 | Not available in this setting | $467.46 | RVU22C |
| 2022-04-01 | Not available in this setting | $467.46 | RVU22B |
| 2022-01-01 | Not available in this setting | $467.46 | RVU22A |
| 2021-10-01 | Not available in this setting | $467.24 | RVU21D |
| 2021-07-01 | Not available in this setting | $467.24 | RVU21C |
| 2021-04-01 | Not available in this setting | $467.24 | RVU21B |
| 2021-01-01 | Not available in this setting | $467.24 | RVU21A |
| 2020-10-01 | Not available in this setting | $462.88 | RVU20D |
| 2020-07-01 | Not available in this setting | $462.88 | RVU20C |
| 2020-04-01 | Not available in this setting | $462.88 | RVU20B |
| 2020-01-01 | Not available in this setting | $462.88 | RVU20A |
| 2019-10-01 | Not available in this setting | $448.34 | RVU19D |
| 2019-07-01 | Not available in this setting | $448.34 | RVU19C |
| 2019-04-01 | Not available in this setting | $448.34 | RVU19B |
| 2019-01-01 | Not available in this setting | $448.34 | RVU19A |
| 2018-10-01 | Not available in this setting | $447.89 | RVU18D |
| 2018-07-01 | Not available in this setting | $447.89 | RVU18C |
| 2018-04-01 | Not available in this setting | $447.89 | RVU18B |
| 2018-01-01 | Not available in this setting | $447.89 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $479.24 | RVU17D |
| 2017-07-01 | Not available in this setting | $479.24 | RVU17C |
| 2017-04-01 | Not available in this setting | $479.24 | RVU17B |
| 2017-01-01 | Not available in this setting | $479.24 | RVU17A |
| 2016-10-01 | Not available in this setting | $455.34 | RVU16D |
| 2016-07-01 | Not available in this setting | $455.34 | RVU16C |
| 2016-04-01 | Not available in this setting | $455.34 | RVU16B |
| 2016-01-01 | Not available in this setting | $455.34 | RVU16A |
| 2015-10-01 | Not available in this setting | $564.84 | RVU15D |
| 2015-07-01 | Not available in this setting | $564.84 | RVU15C |
| 2015-04-01 | Not available in this setting | $562.03 | RVU15B |
| 2015-01-01 | Not available in this setting | $562.03 | RVU15A |
| 2014-10-01 | Not available in this setting | $453.44 | RVU14D |
| 2014-07-01 | Not available in this setting | $453.44 | RVU14C |
| 2014-04-01 | Not available in this setting | $453.44 | RVU14B |
| 2014-01-01 | Not available in this setting | $453.44 | RVU14A |
| 2013-10-01 | Not available in this setting | $455.90 | RVU13D |
| 2013-07-01 | Not available in this setting | Rate data unavailable | RVU13C |
| 2013-04-01 | Not available in this setting | Rate data unavailable | RVU13B |
| 2013-01-01 | Not available in this setting | Rate data unavailable | RVU13AR |
Where the Nevada rate applies
Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.
- Alamo
- Amargosa Valley
- Austin
- Baker
- Battle Mountain
- Beatty
- Beaverdam
- Bennett Springs
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
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