CPT code 49436: Catheter revision, surgical exposure of exit site2026 Medicare rate & RVUs in Washington, DC area
Revision of a peritoneal dialysis catheter involving surgical exposure of its exit site, including treatment of an embedded catheter or correction of malposition.
In Washington, DC area, Medicare pays $650.14 for 49436 in the office and $196.87 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 49436 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 49436 covers
This service involves surgically exposing the exit site of an existing peritoneal dialysis catheter to revise it, such as freeing an embedded catheter or correcting its position. It is typically performed by a surgeon caring for patients whose catheter needs operative revision before or during use for peritoneal dialysis. The operative report should establish the existing catheter, the reason for revision, and the exposure and corrective work performed.
Report this code for the exit-site revision rather than for placement of a new catheter or removal alone. Document the catheter’s condition and the steps taken to expose and revise it. CMS assigns a 10-day global period, so related postoperative visits during that period are included. 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 multiple procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is 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 Washington, DC area compares for 49436
Across 109 of 109 payment localities, the office rate for 49436 runs from $487.83 in Arkansas to $761.12 in San Benito County, CA. Washington, DC area pays $650.14. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Washington, DC area · this page$650.14
- Los Angeles, CA · California$641.05−$9.09
- Miami, FL · Florida$615.70−$34.44
- Chicago, IL · Illinois$594.76−$55.38
- Manhattan, NY · New York$654.55+$4.41
- Alaska · Alaska$625.86−$24.28
- Alabama · Alabama$496.21−$153.93
Other areas in District of Columbia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ArkansasArkansas | $487.83 | $157.31 |
| ArizonaArizona | $545.21 | $172.36 |
| Bakersfield, CACalifornia | $598.59 | $176.87 |
| Chico, CACalifornia | $596.76 | $175.04 |
| El Centro, CACalifornia | $596.87 | $175.15 |
| Fresno, CACalifornia | $596.76 | $175.04 |
| Hanford, CACalifornia | $596.76 | $175.04 |
| Madera, CACalifornia | $596.76 | $175.04 |
| Merced, CACalifornia | $596.76 | $175.04 |
| Modesto, CACalifornia | $596.76 | $175.04 |
| Napa, CACalifornia | $700.37 | $193.23 |
| Oxnard, CACalifornia | $638.51 | $183.71 |
| Redding, CACalifornia | $596.76 | $175.04 |
| Rest of CaliforniaCalifornia | $596.76 | $175.04 |
| Riverside, CACalifornia | $604.05 | $182.33 |
| Sacramento, CACalifornia | $628.67 | $181.17 |
| Salinas, CACalifornia | $626.42 | $180.47 |
| San Diego, CACalifornia | $643.17 | $182.97 |
| Marin County, CACalifornia | $743.60 | $201.07 |
| San Francisco, CACalifornia | $742.83 | $200.29 |
| San Benito County, CACalifornia | $761.12 | $206.27 |
| Santa Clara County, CACalifornia | $757.96 | $203.11 |
| San Luis Obispo, CACalifornia | $616.16 | $177.90 |
| Santa Cruz, CACalifornia | $650.81 | $183.30 |
| Santa Maria, CACalifornia | $629.32 | $180.67 |
| Santa Rosa, CACalifornia | $657.47 | $184.96 |
| Stockton, CACalifornia | $596.76 | $175.04 |
| Vallejo, CACalifornia | $699.26 | $192.12 |
| Visalia, CACalifornia | $596.76 | $175.04 |
| Yuba City, CACalifornia | $596.76 | $175.04 |
| ColoradoColorado | $587.44 | $178.03 |
| ConnecticutConnecticut | $603.76 | $189.35 |
| DelawareDelaware | $555.20 | $175.04 |
| Fort Lauderdale, FLFlorida | $586.69 | $196.91 |
| Rest of FloridaFlorida | $554.04 | $186.19 |
| Atlanta, GAGeorgia | $574.52 | $183.59 |
| Rest of GeorgiaGeorgia | $518.10 | $174.88 |
| Hawaii, Guam, HIHawaii | $614.73 | $177.24 |
| IowaIowa | $510.42 | $158.35 |
| IdahoIdaho | $514.40 | $160.41 |
| East St. Louis, ILIllinois | $549.40 | $195.41 |
| Rest of IllinoisIllinois | $536.00 | $184.70 |
| Suburban Chicago, ILIllinois | $592.81 | $197.64 |
| IndianaIndiana | $517.86 | $161.17 |
| KansasKansas | $507.89 | $160.05 |
| KentuckyKentucky | $510.45 | $168.38 |
| New Orleans, LALouisiana | $538.94 | $176.86 |
| Rest of LouisianaLouisiana | $509.62 | $169.10 |
| Metropolitan Boston, MAMassachusetts | $651.14 | $191.72 |
| Rest of MassachusettsMassachusetts | $583.19 | $178.02 |
| Baltimore area, MDMaryland | $602.21 | $189.34 |
| Rest of MarylandMaryland | $566.91 | $177.51 |
| Rest of MaineMaine | $517.79 | $163.79 |
| Southern Maine, MEMaine | $550.03 | $168.71 |
| Detroit, MIMichigan | $562.26 | $190.95 |
| Rest of MichiganMichigan | $526.14 | $174.84 |
| MinnesotaMinnesota | $559.57 | $163.63 |
| Metropolitan Kansas City, MOMissouri | $534.42 | $173.12 |
| Metropolitan St. Louis, MOMissouri | $540.86 | $174.55 |
| Rest of MissouriMissouri | $499.61 | $167.93 |
| MississippiMississippi | $493.82 | $162.53 |
| MontanaMontana | $562.43 | $177.65 |
| North CarolinaNorth Carolina | $524.04 | $165.04 |
| North DakotaNorth Dakota | $548.98 | $164.20 |
| NebraskaNebraska | $513.60 | $158.45 |
| New HampshireNew Hampshire | $578.13 | $177.58 |
| Northern New JerseyNew Jersey | $641.79 | $195.45 |
| Rest of New JerseyNew Jersey | $609.73 | $189.55 |
| New MexicoNew Mexico | $529.58 | $176.74 |
| NevadaNevada | $559.13 | $173.97 |
| NYC suburbs and Long Island, NYNew York | $672.89 | $215.38 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $614.09 | $192.76 |
| Queens, NYNew York | $660.30 | $205.49 |
| Rest of New YorkNew York | $533.16 | $167.62 |
| OhioOhio | $523.39 | $172.09 |
| OklahomaOklahoma | $509.12 | $165.52 |
| Portland, OROregon | $608.16 | $180.67 |
| Rest of OregonOregon | $553.92 | $170.68 |
| Metropolitan Philadelphia, PAPennsylvania | $586.95 | $186.39 |
| Rest of PennsylvaniaPennsylvania | $524.22 | $170.99 |
| Puerto RicoPuerto Rico | $567.09 | $178.08 |
| Rhode IslandRhode Island | $576.59 | $179.11 |
| South CarolinaSouth Carolina | $524.77 | $169.23 |
| South DakotaSouth Dakota | $547.39 | $162.61 |
| TennesseeTennessee | $510.89 | $161.13 |
| Austin, TXTexas | $586.23 | $179.14 |
| Beaumont, TXTexas | $520.25 | $170.10 |
| Brazoria, TXTexas | $554.12 | $172.81 |
| Dallas, TXTexas | $558.24 | $175.00 |
| Fort Worth, TXTexas | $554.02 | $174.63 |
| Galveston, TXTexas | $556.11 | $174.03 |
| Houston, TXTexas | $568.56 | $186.48 |
| Rest of TexasTexas | $537.25 | $172.10 |
| UtahUtah | $533.08 | $171.39 |
| VirginiaVirginia | $548.12 | $169.89 |
| Virgin Islands, VIUnited States Virgin Islands | $567.09 | $178.08 |
| VermontVermont | $546.74 | $165.81 |
| Rest of WashingtonWashington | $582.11 | $176.94 |
| King County, WAWashington | $665.17 | $193.05 |
| WisconsinWisconsin | $527.80 | $159.18 |
| West VirginiaWest Virginia | $513.15 | $178.77 |
| WyomingWyoming | $556.57 | $171.79 |
49436 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.
$487.83
$678.94
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $625.86 | 1 |
| AL | $496.21 | 1 |
| AR | $487.83 | 1 |
| AZ | $545.21 | 1 |
| CA | $596.76–$761.12 | 29 |
| CO | $587.44 | 1 |
| CT | $603.76 | 1 |
| DC | $650.14 | 1 |
| DE | $555.20 | 1 |
| FL | $554.04–$615.70 | 3 |
| GA | $518.10–$574.52 | 2 |
| GU | $614.73 | 1 |
| HI | $614.73 | 1 |
| IA | $510.42 | 1 |
| ID | $514.40 | 1 |
| IL | $536.00–$594.76 | 4 |
| IN | $517.86 | 1 |
| KS | $507.89 | 1 |
| KY | $510.45 | 1 |
| LA | $509.62–$538.94 | 2 |
| MA | $583.19–$651.14 | 2 |
| MD | $566.91–$650.14 | 3 |
| ME | $517.79–$550.03 | 2 |
| MI | $526.14–$562.26 | 2 |
| MN | $559.57 | 1 |
| MO | $499.61–$540.86 | 3 |
| MS | $493.82 | 1 |
| MT | $562.43 | 1 |
| NC | $524.04 | 1 |
| ND | $548.98 | 1 |
| NE | $513.60 | 1 |
| NH | $578.13 | 1 |
| NJ | $609.73–$641.79 | 2 |
| NM | $529.58 | 1 |
| NV | $559.13 | 1 |
| NY | $533.16–$672.89 | 5 |
| OH | $523.39 | 1 |
| OK | $509.12 | 1 |
| OR | $553.92–$608.16 | 2 |
| PA | $524.22–$586.95 | 2 |
| PR | $567.09 | 1 |
| RI | $576.59 | 1 |
| SC | $524.77 | 1 |
| SD | $547.39 | 1 |
| TN | $510.89 | 1 |
| TX | $520.25–$586.23 | 8 |
| UT | $533.08 | 1 |
| VA | $548.12–$650.14 | 2 |
| VI | $567.09 | 1 |
| VT | $546.74 | 1 |
| WA | $582.11–$665.17 | 2 |
| WI | $527.80 | 1 |
| WV | $513.15 | 1 |
| WY | $556.57 | 1 |
How the 49436 rate is calculated
Each of 49436’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 · 49436
RVUs × geographic indexes × conversion factor
Work2.65
2.65 RVUs× 1.000 GPCI
Practice expense13.51
13.51 RVUs× 1.000 GPCI
Malpractice0.68
0.68 RVUs× 1.000 GPCI
Adjusted RVUs
16.8400
Conversion factor
$33.4009
Medicare rate
$562.47
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Washington, DC area inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,811
- Code
- 49436
- Physician work
- 2.65
- Practice expense
- 13.51
- Malpractice
- 0.68
GPCI2026.csv
39
- Locality
- Washington, DC area
- Physician work
- 1.054
- Practice expense
- 1.178
- Malpractice
- 1.113
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.65 | × 1.054 | 2.7931 |
| Practice expense | 13.51 | × 1.178 | 15.9148 |
| Malpractice | 0.68 | × 1.113 | 0.7568 |
| Total RVUs | 19.4647 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Washington, DC area$650.14
Office: (2.65 × 1.054 + 13.51 × 1.178 + 0.68 × 1.113) × $33.4009 = $650.14
Facility: (2.65 × 1.054 + 1.99 × 1.178 + 0.68 × 1.113) × $33.4009 = $196.87
Payment rules and modifiers for 49436
49436 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49436
Catheter revision, surgical exposure of exit site
| 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) | 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. |
| 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 · 49436
Catheter revision, surgical exposure of exit site
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
49436 without 51 · national office
$562.47
Catheter revision, surgical exposure of exit site
49436-51 · Second procedure: 50%
$281.24
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 49436 has changed in Washington, DC area
49436 · Office / nonfacility
$650.14
Effective 2026-10-01
The base rate is $57.96 higher than on 2025-10-01, moving from $592.18 to $650.14 (9.8%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$592.18changed to$650.14
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 2.72 changed to 2.65
- Practice expense RVU 12.29 changed to 13.51
- Malpractice RVU 0.67 changed to 0.68
- Work GPCI 1.057 changed to 1.054
- Practice expense GPCI 1.192 changed to 1.178
- Malpractice GPCI 1.168 changed to 1.113
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$625.26changed to$592.18
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 12.67 changed to 12.29
- Malpractice RVU 0.69 changed to 0.67
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$615.05changed to$625.26
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$660.50changed to$615.05
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 13.02 changed to 12.67
- Malpractice RVU 0.66 changed to 0.69
- Work GPCI 1.056 changed to 1.057
- Practice expense GPCI 1.214 changed to 1.192
- Malpractice GPCI 1.231 changed to 1.168
January 1, 2023
RVU23A
No ratechanged to$660.50
Held through RVU23B, RVU23C, RVU23D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $650.14 | $196.87 | RVU26D |
| 2026-07-01 | $650.14 | $196.87 | RVU26C |
| 2026-04-01 | $650.14 | $196.87 | RVU26B |
| 2026-01-01 | $650.14 | $196.87 | RVU26A |
| 2025-10-01 | $592.18 | $205.06 | RVU25D |
| 2025-07-01 | $592.18 | $205.06 | RVU25C |
| 2025-04-01 | $592.18 | $205.06 | RVU25B |
| 2025-01-01 | $592.18 | $205.06 | RVU25A |
| 2024-10-01 | $625.26 | $209.82 | RVU24D |
| 2024-07-01 | $625.26 | $209.82 | RVU24C |
| 2024-04-01 | $625.26 | $209.82 | RVU24B |
| 2024-03-09 | $625.26 | $209.82 | RVU24AR |
| 2024-01-01 | $615.05 | $206.40 | RVU24A |
| 2023-10-01 | $660.50 | $214.55 | RVU23D |
| 2023-07-01 | $660.50 | $214.55 | RVU23C |
| 2023-04-01 | $660.50 | $214.55 | RVU23B |
| 2023-01-01 | $660.50 | $214.55 | RVU23A |
| 2022-10-01 | Not available in this setting | $224.60 | RVU22D |
| 2022-07-01 | Not available in this setting | $224.60 | RVU22C |
| 2022-04-01 | Not available in this setting | $224.60 | RVU22B |
| 2022-01-01 | Not available in this setting | $224.60 | RVU22A |
| 2021-10-01 | Not available in this setting | $223.83 | RVU21D |
| 2021-07-01 | Not available in this setting | $223.83 | RVU21C |
| 2021-04-01 | Not available in this setting | $223.83 | RVU21B |
| 2021-01-01 | Not available in this setting | $223.83 | RVU21A |
| 2020-10-01 | Not available in this setting | $223.24 | RVU20D |
| 2020-07-01 | Not available in this setting | $223.24 | RVU20C |
| 2020-04-01 | Not available in this setting | $223.24 | RVU20B |
| 2020-01-01 | Not available in this setting | $223.24 | RVU20A |
| 2019-10-01 | Not available in this setting | $218.36 | RVU19D |
| 2019-07-01 | Not available in this setting | $218.36 | RVU19C |
| 2019-04-01 | Not available in this setting | $218.36 | RVU19B |
| 2019-01-01 | Not available in this setting | $218.36 | RVU19A |
| 2018-10-01 | Not available in this setting | $219.01 | RVU18D |
| 2018-07-01 | Not available in this setting | $219.01 | RVU18C |
| 2018-04-01 | Not available in this setting | $219.01 | RVU18B |
| 2018-01-01 | Not available in this setting | $219.01 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $219.31 | RVU17D |
| 2017-07-01 | Not available in this setting | $219.31 | RVU17C |
| 2017-04-01 | Not available in this setting | $219.31 | RVU17B |
| 2017-01-01 | Not available in this setting | $219.31 | RVU17A |
| 2016-10-01 | Not available in this setting | $220.13 | RVU16D |
| 2016-07-01 | Not available in this setting | $220.13 | RVU16C |
| 2016-04-01 | Not available in this setting | $220.13 | RVU16B |
| 2016-01-01 | Not available in this setting | $220.13 | RVU16A |
| 2015-10-01 | Not available in this setting | $220.47 | RVU15D |
| 2015-07-01 | Not available in this setting | $220.47 | RVU15C |
| 2015-04-01 | Not available in this setting | $219.37 | RVU15B |
| 2015-01-01 | Not available in this setting | $219.37 | RVU15A |
| 2014-10-01 | Not available in this setting | $213.89 | RVU14D |
| 2014-07-01 | Not available in this setting | $213.89 | RVU14C |
| 2014-04-01 | Not available in this setting | $213.89 | RVU14B |
| 2014-01-01 | Not available in this setting | $213.89 | RVU14A |
| 2013-10-01 | Not available in this setting | $213.10 | RVU13D |
| 2013-07-01 | Not available in this setting | $213.10 | RVU13C |
| 2013-04-01 | Not available in this setting | $213.10 | RVU13B |
| 2013-01-01 | Not available in this setting | $213.10 | RVU13AR |
Where the Washington, DC area rate applies
Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.
- Washington
49436 billing questions
When should I report this instead of a new-catheter insertion code?
Report this service when the surgeon exposes and revises an existing catheter exit site, such as to free an embedded catheter or correct malposition. A new catheter insertion is a different service.
Is this code appropriate for an embedded peritoneal dialysis catheter?
Yes, when the embedded catheter is surgically exposed as part of the revision. The operative note should describe the exposure and any corrective work.
Are related postoperative visits separately reportable?
Related postoperative visits during the 10-day global period are included in this procedure’s payment.
Can I append modifier 50 for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation.
What documentation supports reporting this service?
Document the existing peritoneal dialysis catheter, why revision was needed, surgical exposure of the exit site, and the revision performed, such as freeing an embedded catheter or correcting its position.
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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