CPT code 50435: Nephrostomy exchange, existing percutaneous access2026 Medicare rate & RVUs
Report this service when a clinician exchanges an existing percutaneous nephrostomy catheter through its established renal access tract, with imaging guidance.
Medicare pays $563.47 for 50435 nationally in the office and $87.84 in a hospital or facility. Local office rates run $490.06–$786.85.
Medicare rate · 50435
Nephrostomy exchange, existing percutaneous access
- Work RVUs
- 1.77
- Total RVUs
- 16.87
- Global days
- 000
National rate · 2026
$563.47
Office setting, before claim adjustments.
See every locality for 50435 →Billed by an NP, PA or therapist? →
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 10 sections
What 50435 covers
An interventional radiologist or urologist exchanges a nephrostomy catheter through the patient’s established percutaneous tract into the renal collecting system. The service is used for routine catheter maintenance or when an existing tube is obstructed, damaged, or no longer functioning adequately. Imaging guides the exchange; contrast evaluation of the collecting system or ureter may be performed as part of the service. It is commonly furnished in a hospital or outpatient imaging setting.
Document the existing access, the catheter exchange, the treated side, and the imaging guidance used. When performed during the exchange, the diagnostic nephrostogram or ureterogram and associated imaging are included. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. With modifier 50, a bilateral procedure is paid at 150%. Assistant-at-surgery payment is restricted; 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.
Where 50435 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$490.06 to $786.85
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $498.36 | $82.19 |
| Alaska | $622.38 | $115.84 |
| Arizona | $547.08 | $86.20 |
| Arkansas | $490.06 | $81.50 |
| Atlanta, GA | $572.96 | $89.72 |
| Austin, TX | $591.69 | $88.48 |
| Bakersfield, CA | $609.76 | $88.47 |
| Baltimore area, MD | $602.33 | $91.98 |
| Beaumont, TX | $518.21 | $85.39 |
| Brazoria, TX | $558.00 | $86.65 |
| Chicago, IL | $575.03 | $97.02 |
| Chico, CA | $609.16 | $87.87 |
| Colorado | $594.57 | $88.50 |
| Connecticut | $604.38 | $92.13 |
| Dallas, TX | $561.07 | $87.34 |
| Delaware | $557.12 | $87.20 |
| Detroit, MI | $550.64 | $91.66 |
| East St. Louis, IL | $530.43 | $92.85 |
| El Centro, CA | $609.19 | $87.90 |
| Fort Lauderdale, FL | $575.34 | $93.53 |
| Fort Worth, TX | $556.18 | $87.21 |
| Fresno, CA | $609.16 | $87.87 |
| Galveston, TX | $559.31 | $87.01 |
| Hanford, CA | $609.16 | $87.87 |
| Hawaii, Guam, HI | $628.84 | $88.05 |
| Houston, TX | $562.97 | $90.67 |
| Idaho | $520.14 | $82.56 |
| Indiana | $523.71 | $82.80 |
| Iowa | $517.14 | $81.94 |
| Kansas | $512.38 | $82.41 |
| Kentucky | $507.66 | $84.83 |
| King County, WA | $678.18 | $94.58 |
| Los Angeles, CA | $654.73 | $92.06 |
| Madera, CA | $609.16 | $87.87 |
| Manhattan, NY | $651.79 | $99.11 |
| Marin County, CA | $769.52 | $98.89 |
| Merced, CA | $609.16 | $87.87 |
| Metropolitan Boston, MA | $661.71 | $93.81 |
| Metropolitan Kansas City, MO | $532.96 | $86.35 |
| Metropolitan Philadelphia, PA | $586.23 | $91.10 |
| Metropolitan St. Louis, MO | $539.60 | $86.80 |
| Miami, FL | $594.09 | $98.96 |
| Minnesota | $573.20 | $83.78 |
| Mississippi | $492.55 | $83.04 |
| Modesto, CA | $609.16 | $87.87 |
| Montana | $563.46 | $87.83 |
| Napa, CA | $722.17 | $95.29 |
| Nebraska | $521.00 | $81.99 |
| Nevada | $562.86 | $86.75 |
| New Hampshire | $583.04 | $87.91 |
| New Mexico | $523.51 | $87.36 |
| New Orleans, LA | $535.02 | $87.45 |
| North Carolina | $527.72 | $83.96 |
| North Dakota | $559.51 | $83.88 |
| Northern New Jersey | $647.28 | $95.55 |
| NYC suburbs and Long Island, NY | $667.04 | $101.52 |
| Ohio | $520.23 | $85.98 |
| Oklahoma | $508.73 | $84.00 |
| Oxnard, CA | $653.19 | $90.99 |
| Portland, OR | $617.95 | $89.53 |
| Poughkeepsie and northern NYC suburbs, NY | $614.82 | $94.00 |
| Puerto Rico | $568.85 | $87.99 |
| Queens, NY | $660.79 | $98.59 |
| Redding, CA | $609.16 | $87.87 |
| Rest of California | $609.16 | $87.87 |
| Rest of Florida | $544.94 | $90.23 |
| Rest of Georgia | $511.01 | $86.75 |
| Rest of Illinois | $523.94 | $89.69 |
| Rest of Louisiana | $505.96 | $85.03 |
| Rest of Maine | $521.13 | $83.56 |
| Rest of Maryland | $569.49 | $88.15 |
| Rest of Massachusetts | $589.44 | $88.60 |
| Rest of Michigan | $521.04 | $86.79 |
| Rest of Missouri | $494.62 | $84.63 |
| Rest of New Jersey | $612.27 | $92.89 |
| Rest of New York | $536.61 | $84.76 |
| Rest of Oregon | $559.50 | $85.77 |
| Rest of Pennsylvania | $522.30 | $85.67 |
| Rest of Texas | $537.44 | $86.07 |
| Rest of Washington | $589.02 | $88.18 |
| Rhode Island | $580.30 | $88.97 |
| Riverside, CA | $611.33 | $90.04 |
| Sacramento, CA | $643.62 | $90.47 |
| Salinas, CA | $641.34 | $90.08 |
| San Benito County, CA | $786.85 | $100.99 |
| San Diego, CA | $659.73 | $90.88 |
| San Francisco, CA | $769.29 | $98.66 |
| San Luis Obispo, CA | $630.56 | $88.81 |
| Santa Clara County, CA | $785.92 | $100.06 |
| Santa Cruz, CA | $668.61 | $90.73 |
| Santa Maria, CA | $644.64 | $90.06 |
| Santa Rosa, CA | $675.62 | $91.54 |
| South Carolina | $524.65 | $85.17 |
| South Dakota | $559.04 | $83.41 |
| Southern Maine, ME | $556.53 | $85.18 |
| Stockton, CA | $609.16 | $87.87 |
| Suburban Chicago, IL | $582.48 | $94.01 |
| Tennessee | $515.09 | $82.75 |
| Utah | $532.93 | $85.84 |
| Vallejo, CA | $721.84 | $94.97 |
| Vermont | $555.20 | $84.32 |
| Virgin Islands, VI | $568.85 | $87.99 |
| Virginia | $553.05 | $85.51 |
| Visalia, CA | $609.16 | $87.87 |
| Washington, DC area | $656.01 | $95.72 |
| West Virginia | $501.16 | $87.84 |
| Wisconsin | $537.95 | $82.30 |
| Wyoming | $561.74 | $86.11 |
| Yuba City, CA | $609.16 | $87.87 |
50435 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.
$490.06
$698.01
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 | $622.38 | 1 |
| AL | $498.36 | 1 |
| AR | $490.06 | 1 |
| AZ | $547.08 | 1 |
| CA | $609.16–$786.85 | 29 |
| CO | $594.57 | 1 |
| CT | $604.38 | 1 |
| DC | $656.01 | 1 |
| DE | $557.12 | 1 |
| FL | $544.94–$594.09 | 3 |
| GA | $511.01–$572.96 | 2 |
| GU | $628.84 | 1 |
| HI | $628.84 | 1 |
| IA | $517.14 | 1 |
| ID | $520.14 | 1 |
| IL | $523.94–$582.48 | 4 |
| IN | $523.71 | 1 |
| KS | $512.38 | 1 |
| KY | $507.66 | 1 |
| LA | $505.96–$535.02 | 2 |
| MA | $589.44–$661.71 | 2 |
| MD | $569.49–$656.01 | 3 |
| ME | $521.13–$556.53 | 2 |
| MI | $521.04–$550.64 | 2 |
| MN | $573.20 | 1 |
| MO | $494.62–$539.60 | 3 |
| MS | $492.55 | 1 |
| MT | $563.46 | 1 |
| NC | $527.72 | 1 |
| ND | $559.51 | 1 |
| NE | $521.00 | 1 |
| NH | $583.04 | 1 |
| NJ | $612.27–$647.28 | 2 |
| NM | $523.51 | 1 |
| NV | $562.86 | 1 |
| NY | $536.61–$667.04 | 5 |
| OH | $520.23 | 1 |
| OK | $508.73 | 1 |
| OR | $559.50–$617.95 | 2 |
| PA | $522.30–$586.23 | 2 |
| PR | $568.85 | 1 |
| RI | $580.30 | 1 |
| SC | $524.65 | 1 |
| SD | $559.04 | 1 |
| TN | $515.09 | 1 |
| TX | $518.21–$591.69 | 8 |
| UT | $532.93 | 1 |
| VA | $553.05–$656.01 | 2 |
| VI | $568.85 | 1 |
| VT | $555.20 | 1 |
| WA | $589.02–$678.18 | 2 |
| WI | $537.95 | 1 |
| WV | $501.16 | 1 |
| WY | $561.74 | 1 |
How the 50435 rate is calculated
Each of 50435’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 · 50435
RVUs × geographic indexes × conversion factor
Work1.77
1.77 RVUs× 1.000 GPCI
Practice expense14.90
14.90 RVUs× 1.000 GPCI
Malpractice0.20
0.20 RVUs× 1.000 GPCI
Adjusted RVUs
16.8700
Conversion factor
$33.4009
Medicare rate
$563.47
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 50435
The CMS indicators that decide how 50435 is paid alongside other services.
CMS payment indicators · 50435
Nephrostomy exchange, existing percutaneous access
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
50435 without 50 · national office
$563.47
Nephrostomy exchange, existing percutaneous access
50435-50 · Bilateral: 150%
$845.21
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).
50435 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 50432Nephrostomy placementNew percutaneous access
- 50435 exchanges a catheter through an existing percutaneous access tract. 50432 is for placing a nephrostomy catheter through new access.
- 50434Catheter conversionNephrostomy to nephroureteral
- Choose 50434 for conversion of a nephrostomy catheter to a nephroureteral catheter; choose 50435 for exchange of a nephrostomy catheter.
- 50430Antegrade nephrostogramExisting access
- 50430 describes an antegrade nephrostogram or ureterogram through existing access. During a 50435 exchange, that diagnostic imaging is included when performed.
50435 billing questions
How is an exchange different from placing a nephrostomy catheter?
Use 50435 when the clinician exchanges a catheter through an existing percutaneous renal access tract. Placement through new access is represented by 50432.
Can the nephrostogram be billed separately during the exchange?
No. The diagnostic nephrostogram or ureterogram, when performed as part of the exchange, is included in 50435.
When is 50434 more appropriate?
Use 50434 when the existing nephrostomy catheter is converted to a nephroureteral catheter, rather than exchanged for another nephrostomy catheter.
How should bilateral exchanges be reported?
CMS identifies 50435 as a bilateral procedure; report modifier 50 when both sides are treated. The bilateral payment is 150%.
What same-session payment reduction may apply?
When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and the others at 50%.
What documentation supports reporting 50435?
Record that a nephrostomy catheter was already present, that it was exchanged through the existing access, the side treated, and the imaging guidance used.
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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