CPT code 49435: Catheter extension, subcutaneous extension2026 Medicare rate & RVUs in Michigan
Reports tunneling and placement of a subcutaneous extension on an intraperitoneal dialysis catheter, such as to create a presternal exit site.
CMS doesn’t publish an office rate for 49435 in Michigan.
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 49435 covers
This service adds a subcutaneous segment to an intraperitoneal catheter and tunnels it to a new exit site, such as the chest for a presternal configuration. It is performed by a surgeon or another clinician who places peritoneal dialysis access, typically in an operative setting. The extension changes where the catheter exits the skin; it is not a service for inserting an entirely new intraperitoneal catheter.
Report 49435 as an add-on with the qualifying open catheter insertion, 49421. The record should identify the existing or concurrently placed catheter, the extension, the tunneling performed, and the intended exit-site location. Do not report it alone or pair it with a different primary insertion code. CMS pays this add-on within the global period of the primary procedure, so it is included in that procedure’s global-period payment.
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 49435 pays more and less in Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | Unavailable | $118.46 |
| Rest of Michigan | Unavailable | $107.15 |
How the 49435 rate is calculated
Each of 49435’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 · 49435
RVUs × geographic indexes × conversion factor
Work2.19
2.19 RVUs× 1.000 GPCI
Practice expense0.41
0.41 RVUs× 1.000 GPCI
Malpractice0.57
0.57 RVUs× 1.000 GPCI
Adjusted RVUs
3.1700
Conversion factor
$33.4009
Medicare rate
$105.88
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49435
The CMS indicators that decide how 49435 is paid alongside other services.
CMS payment indicators · 49435
Catheter extension, subcutaneous extension
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
49435 without 80 · national facility
$105.88
Catheter extension, subcutaneous extension
49435-80 · Assistant: 16%
$16.94
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
49435 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49421Dialysis catheter placementOpen, tunneled peritoneal access
- 49421 reports open insertion of the tunneled intraperitoneal catheter; 49435 adds the subcutaneous extension and is reported with that primary procedure.
- 49418Peritoneal catheterPercutaneous tunneled placement
- 49418 reports percutaneous insertion of a tunneled intraperitoneal catheter. 49435 is an extension add-on paired with 49421, not a substitute for the percutaneous insertion code.
- 49436Catheter revisionSurgical exposure of exit site
- 49436 addresses externalizing a previously implanted buried catheter. Use 49435 for adding and tunneling a subcutaneous extension.
49435 billing questions
Which primary code is paired with 49435?
Report 49435 with 49421 for open insertion of a tunneled intraperitoneal dialysis catheter. It is not a stand-alone code.
When is an extension distinct from catheter insertion?
49435 describes adding and tunneling a subcutaneous segment to create a different exit site, such as a presternal site. It does not describe placing the intraperitoneal catheter itself.
What documentation supports 49435?
Document the catheter involved, the subcutaneous extension and tunneling, and the resulting exit-site location. The record should also support the qualifying 49421 primary procedure.
Is 49435 paid separately during the global period?
CMS identifies 49435 as an add-on paid within the primary procedure’s global period. Report it with 49421 rather than as a separate stand-alone service.
Can 49435 be used when a buried catheter is brought out through the skin?
That circumstance is described by 49436, which addresses externalizing a previously implanted catheter. 49435 is for adding a subcutaneous extension.
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
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