CPT code 50434: Catheter conversion, nephrostomy to nephroureteral2026 Medicare rate & RVUs in Vermont

Reports percutaneous conversion of an existing nephrostomy catheter into a nephroureteral catheter, carrying the catheter through the ureter toward the bladder.

CMS RVU26DEffective Oct 1, 2026One payment locality1.8K Medicare services in 2024

In Vermont, Medicare pays $851.03 for 50434 in the office and $159.60 when it’s performed in a hospital or facility.

$851.03Office (non-facility)
$159.60Hospital or facility
−1.6%vs the national office rate ($865.08)

Check a contract rate as a % of Medicare · 50434 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 50434 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Vermont
  2. What 50434 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 50434 covers

An interventional radiologist or other qualified physician uses an existing percutaneous kidney access to redirect a nephrostomy catheter through the ureter, typically positioning its distal end in the bladder. This changes the drainage route from a catheter confined to the kidney to one that traverses the ureter. Fluoroscopic or other imaging guidance and a contrast study of the collecting system or ureter may be part of the procedure.

Report 50434 when an existing nephrostomy catheter is converted; documentation should identify the prior access and catheter, the route established, and the final catheter position. Imaging guidance, associated radiological supervision and interpretation, and a nephrostogram or ureterogram when performed are included. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued is paid in full and other procedures at 50%. For bilateral conversion, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery 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 Vermont compares for 50434

Across 109 of 109 payment localities, the office rate for 50434 runs from $755.63 in Arkansas to $1,194.46 in San Benito County, CA. Vermont pays $851.03. The RVUs are the same everywhere; the geographic indexes change the dollars.

50434 in Vermont vs other payment areas
  1. Vermont · this page$851.03
  2. Los Angeles, CA · California$998.93+$147.90
  3. Washington, DC area · District of Columbia$1,003.02+$151.99
  4. Miami, FL · Florida$915.92+$64.89
  5. Chicago, IL · Illinois$887.32+$36.29
  6. Manhattan, NY · New York$999.05+$148.02
  7. Alaska · Alaska$967.45+$116.42

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

Every other payment area

50434 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$768.00$156.89
ArkansasArkansas$755.63$155.70
ArizonaArizona$840.51$163.75
Bakersfield, CACalifornia$932.05$166.59
Chico, CACalifornia$930.80$165.34
El Centro, CACalifornia$930.87$165.41
Fresno, CACalifornia$930.80$165.34
Hanford, CACalifornia$930.80$165.34

50434 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.

$755.63

$1,062.63

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
50434 office rate range by state
State / territoryOffice rate rangeLocalities
AK$967.451
AL$768.001
AR$755.631
AZ$840.511
CA$930.80–$1,194.4629
CO$910.221
CT$926.551
DC$1,003.021
DE$855.561
FL$839.89–$915.923
GA$788.97–$879.872
GU$959.211
HI$959.211
IA$794.851
ID$799.541
IL$809.36–$896.204
IN$804.821
KS$788.291
KY$782.981
LA$780.66–$823.932
MA$902.90–$1,010.042
MD$873.93–$1,003.023
ME$801.58–$853.472
MI$803.41–$848.962
MN$876.591
MO$764.11–$830.113
MS$760.161
MT$865.061
NC$811.291
ND$856.951
NE$800.421
NH$893.271
NJ$938.38–$990.382
NM$807.321
NV$863.531
NY$824.56–$1,022.455
OH$801.761
OK$784.011
OR$858.10–$944.472
PA$804.54–$899.822
PR$872.901
RI$889.991
SC$807.611
SD$855.991
TN$792.391
TX$798.49–$906.068
UT$819.941
VA$848.66–$1,003.022
VI$872.901
VT$851.031
WA$902.04–$1,034.202
WI$824.981
WV$775.471
WY$861.521

See 50434 in every payment locality

How the 50434 rate is calculated

Each of 50434’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 · 50434

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.66

3.66 RVUs× 1.000 GPCI

Practice expense21.83

21.83 RVUs× 1.000 GPCI

Malpractice0.41

0.41 RVUs× 1.000 GPCI

Adjusted RVUs

25.9000

Conversion factor

$33.4009

Medicare rate

$865.08

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

The exact Vermont inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,921

Code
50434
Physician work
3.66
Practice expense
21.83
Malpractice
0.41

GPCI2026.csv

105

Locality
Vermont
Physician work
1.000
Practice expense
0.990
Malpractice
0.506
Office calculation for 50434 in Vermont
ComponentRVULocality factorAdjusted
Physician work3.66× 1.0003.6600
Practice expense21.83× 0.99021.6117
Malpractice0.41× 0.5060.2075
Total RVUs25.4792
Conversion factor× 33.4009

Office rate, Vermont$851.03

Office: (3.66 × 1 + 21.83 × 0.99 + 0.41 × 0.506) × $33.4009 = $851.03

Facility: (3.66 × 1 + 0.92 × 0.99 + 0.41 × 0.506) × $33.4009 = $159.60

Open 50434 in the RVU calculator

Payment rules and modifiers for 50434

The CMS indicators that decide how 50434 is paid alongside other services.

CMS payment indicators · 50434

Catheter conversion, nephrostomy to nephroureteral

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
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.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

50434 without 50 · national office

$865.08

Catheter conversion, nephrostomy to nephroureteral

50434-50 · Bilateral: 150%

$1,297.62

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

How 50434 has changed in Vermont

50434 · Office / nonfacility

$851.03

Effective 2026-10-01

The base rate is $18.48 higher than on 2025-10-01, moving from $832.55 to $851.03 (2.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

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
  1. January 1, 2026

    RVU26A

    $832.55changed to$851.03

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.75 changed to 3.66
    • Practice expense RVU 21.94 changed to 21.83
    • Malpractice RVU 0.39 changed to 0.41
    • Practice expense GPCI 0.993 changed to 0.990
    • Malpractice GPCI 0.518 changed to 0.506

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $877.77changed to$832.55

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 22.57 changed to 21.94
    • Malpractice RVU 0.40 changed to 0.39

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $863.44changed to$877.77

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $922.10changed to$863.44

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 23.33 changed to 22.57
    • Malpractice RVU 0.37 changed to 0.40
    • Practice expense GPCI 0.997 changed to 0.993
    • Malpractice GPCI 0.543 changed to 0.518
  5. January 1, 2023

    RVU23A

    $967.15changed to$922.10

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 23.98 changed to 23.33
    • Malpractice RVU 0.34 changed to 0.37
    • Practice expense GPCI 1.001 changed to 0.997
    • Malpractice GPCI 0.569 changed to 0.543

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $979.86changed to$967.15

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 24.12 changed to 23.98
    • Malpractice RVU 0.33 changed to 0.34

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $942.02changed to$979.86

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 21.99 changed to 24.12
    • Malpractice RVU 0.32 changed to 0.33
    • Practice expense GPCI 1.008 changed to 1.001
    • Malpractice GPCI 0.582 changed to 0.569

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $895.03changed to$942.02

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 20.58 changed to 21.99
    • Malpractice RVU 0.33 changed to 0.32
    • Practice expense GPCI 1.015 changed to 1.008
    • Malpractice GPCI 0.595 changed to 0.582

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $852.55changed to$895.03

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 19.45 changed to 20.58
    • Malpractice RVU 0.32 changed to 0.33

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $847.76changed to$852.55

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 19.46 changed to 19.45
    • Malpractice RVU 0.34 changed to 0.32
    • Practice expense GPCI 1.010 changed to 1.015
    • Malpractice GPCI 0.639 changed to 0.595

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $915.17changed to$847.76

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 4.00 changed to 3.75
    • Practice expense RVU 21.23 changed to 19.46
    • Malpractice RVU 0.36 changed to 0.34
    • Practice expense GPCI 1.004 changed to 1.010
    • Malpractice GPCI 0.682 changed to 0.639

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    No ratechanged to$915.17

    Held through RVU16B, RVU16C, RVU16D.

  13. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$851.03$159.60RVU26D
2026-07-01$851.03$159.60RVU26C
2026-04-01$851.03$159.60RVU26B
2026-01-01$851.03$159.60RVU26A
2025-10-01$832.55$175.05RVU25D
2025-07-01$832.55$175.05RVU25C
2025-04-01$832.55$175.05RVU25B
2025-01-01$832.55$175.05RVU25A
2024-10-01$877.77$178.33RVU24D
2024-07-01$877.77$178.33RVU24C
2024-04-01$877.77$178.33RVU24B
2024-03-09$877.77$178.33RVU24AR
2024-01-01$863.44$175.42RVU24A
2023-10-01$922.10$182.87RVU23D
2023-07-01$922.10$182.87RVU23C
2023-04-01$922.10$182.87RVU23B
2023-01-01$922.10$182.87RVU23A
2022-10-01$967.15$185.66RVU22D
2022-07-01$967.15$185.66RVU22C
2022-04-01$967.15$185.66RVU22B
2022-01-01$967.15$185.66RVU22A
2021-10-01$979.86$188.05RVU21D
2021-07-01$979.86$188.05RVU21C
2021-04-01$979.86$188.05RVU21B
2021-01-01$979.86$188.05RVU21A
2020-10-01$942.02$196.26RVU20D
2020-07-01$942.02$196.26RVU20C
2020-04-01$942.02$196.26RVU20B
2020-01-01$942.02$196.26RVU20A
2019-10-01$895.03$197.82RVU19D
2019-07-01$895.03$197.82RVU19C
2019-04-01$895.03$197.82RVU19B
2019-01-01$895.03$197.82RVU19A
2018-10-01$852.55$198.85RVU18D
2018-07-01$852.55$198.85RVU18C
2018-04-01$852.55$198.85RVU18B
2018-01-01$852.55$198.85RVU18AR1
2017-10-01$847.76$200.01RVU17D
2017-07-01$847.76$200.01RVU17C
2017-04-01$847.76$200.01RVU17B
2017-01-01$847.76$200.01RVU17A
2016-10-01$915.17$212.76RVU16D
2016-07-01$915.17$212.76RVU16C
2016-04-01$915.17$212.76RVU16B
2016-01-01$915.17$212.76RVU16A
2015-10-01Not in this releaseNot in this releaseRVU15D
2015-07-01Not in this releaseNot in this releaseRVU15C
2015-04-01Not in this releaseNot in this releaseRVU15B
2015-01-01Not in this releaseNot in this releaseRVU15A
2014-10-01Not in this releaseNot in this releaseRVU14D
2014-07-01Not in this releaseNot in this releaseRVU14C
2014-04-01Not in this releaseNot in this releaseRVU14B
2014-01-01Not in this releaseNot in this releaseRVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 50434 for an earlier date of service

Where the Vermont rate applies

Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.

  • Albany
  • Alburgh
  • Algiers
  • Arlington
  • Ascutney
  • Bakersfield
  • Barnet
  • Barre

Browse all communities in Vermont

50434 billing questions

When should 50434 be used instead of 50433?

Use 50434 when an existing nephrostomy catheter is converted to a nephroureteral catheter. Use 50433 for placement of a nephroureteral catheter rather than conversion of an existing nephrostomy catheter.

Is exchanging a nephrostomy catheter the same service?

No. A routine exchange of a nephrostomy catheter is reported with 50435; 50434 describes converting the existing access to a nephroureteral drainage route.

Can the nephrostogram or imaging guidance be billed separately?

Imaging guidance, related radiological supervision and interpretation, and a nephrostogram or ureterogram performed as part of the conversion are included in 50434.

What should the procedure note establish?

Document the existing nephrostomy access, the catheter manipulation through the ureter, and the final catheter course and position. Include imaging findings that support the conversion when imaging is performed.

How is bilateral conversion reported?

When conversion is performed on both sides, report modifier 50; CMS pays the bilateral procedure at 150%.

How does Medicare handle other procedures performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures in that session are paid at 50%. The code has a 0-day global period, and Medicare does not pay an assistant at surgery.

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 50434PPRRVU2026_Oct_nonQPP.csv, line 5,921 (RVU26D)
Geographic factors for VermontGPCI2026.csv, line 105 (RVU26D)

Open CMS sourceHow we calculate rates

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