CPT code 50435: Nephrostomy exchange, existing percutaneous access2026 Medicare rate & RVUs in Virgin Islands, VI
Report this service when a clinician exchanges an existing percutaneous nephrostomy catheter through its established renal access tract, with imaging guidance.
In Virgin Islands, VI, Medicare pays $568.85 for 50435 in the office and $87.99 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 50435 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 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.
How Virgin Islands, VI compares for 50435
Across 109 of 109 payment localities, the office rate for 50435 runs from $490.06 in Arkansas to $786.85 in San Benito County, CA. Virgin Islands, VI pays $568.85. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Virgin Islands, VI · this page$568.85
- Los Angeles, CA · California$654.73+$85.88
- Washington, DC area · District of Columbia$656.01+$87.16
- Miami, FL · Florida$594.09+$25.24
- Chicago, IL · Illinois$575.03+$6.18
- Manhattan, NY · New York$651.79+$82.94
- Alaska · Alaska$622.38+$53.53
Other areas in United States Virgin Islands first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $498.36 | $82.19 |
| ArkansasArkansas | $490.06 | $81.50 |
| ArizonaArizona | $547.08 | $86.20 |
| Bakersfield, CACalifornia | $609.76 | $88.47 |
| Chico, CACalifornia | $609.16 | $87.87 |
| El Centro, CACalifornia | $609.19 | $87.90 |
| Fresno, CACalifornia | $609.16 | $87.87 |
| Hanford, CACalifornia | $609.16 | $87.87 |
| Madera, CACalifornia | $609.16 | $87.87 |
| Merced, CACalifornia | $609.16 | $87.87 |
| Modesto, CACalifornia | $609.16 | $87.87 |
| Napa, CACalifornia | $722.17 | $95.29 |
| Oxnard, CACalifornia | $653.19 | $90.99 |
| Redding, CACalifornia | $609.16 | $87.87 |
| Rest of CaliforniaCalifornia | $609.16 | $87.87 |
| Riverside, CACalifornia | $611.33 | $90.04 |
| Sacramento, CACalifornia | $643.62 | $90.47 |
| Salinas, CACalifornia | $641.34 | $90.08 |
| San Diego, CACalifornia | $659.73 | $90.88 |
| Marin County, CACalifornia | $769.52 | $98.89 |
| San Francisco, CACalifornia | $769.29 | $98.66 |
| San Benito County, CACalifornia | $786.85 | $100.99 |
| Santa Clara County, CACalifornia | $785.92 | $100.06 |
| San Luis Obispo, CACalifornia | $630.56 | $88.81 |
| Santa Cruz, CACalifornia | $668.61 | $90.73 |
| Santa Maria, CACalifornia | $644.64 | $90.06 |
| Santa Rosa, CACalifornia | $675.62 | $91.54 |
| Stockton, CACalifornia | $609.16 | $87.87 |
| Vallejo, CACalifornia | $721.84 | $94.97 |
| Visalia, CACalifornia | $609.16 | $87.87 |
| Yuba City, CACalifornia | $609.16 | $87.87 |
| ColoradoColorado | $594.57 | $88.50 |
| ConnecticutConnecticut | $604.38 | $92.13 |
| DelawareDelaware | $557.12 | $87.20 |
| Fort Lauderdale, FLFlorida | $575.34 | $93.53 |
| Rest of FloridaFlorida | $544.94 | $90.23 |
| Atlanta, GAGeorgia | $572.96 | $89.72 |
| Rest of GeorgiaGeorgia | $511.01 | $86.75 |
| Hawaii, Guam, HIHawaii | $628.84 | $88.05 |
| IowaIowa | $517.14 | $81.94 |
| IdahoIdaho | $520.14 | $82.56 |
| East St. Louis, ILIllinois | $530.43 | $92.85 |
| Rest of IllinoisIllinois | $523.94 | $89.69 |
| Suburban Chicago, ILIllinois | $582.48 | $94.01 |
| IndianaIndiana | $523.71 | $82.80 |
| KansasKansas | $512.38 | $82.41 |
| KentuckyKentucky | $507.66 | $84.83 |
| New Orleans, LALouisiana | $535.02 | $87.45 |
| Rest of LouisianaLouisiana | $505.96 | $85.03 |
| Metropolitan Boston, MAMassachusetts | $661.71 | $93.81 |
| Rest of MassachusettsMassachusetts | $589.44 | $88.60 |
| Baltimore area, MDMaryland | $602.33 | $91.98 |
| Rest of MarylandMaryland | $569.49 | $88.15 |
| Rest of MaineMaine | $521.13 | $83.56 |
| Southern Maine, MEMaine | $556.53 | $85.18 |
| Detroit, MIMichigan | $550.64 | $91.66 |
| Rest of MichiganMichigan | $521.04 | $86.79 |
| MinnesotaMinnesota | $573.20 | $83.78 |
| Metropolitan Kansas City, MOMissouri | $532.96 | $86.35 |
| Metropolitan St. Louis, MOMissouri | $539.60 | $86.80 |
| Rest of MissouriMissouri | $494.62 | $84.63 |
| MississippiMississippi | $492.55 | $83.04 |
| MontanaMontana | $563.46 | $87.83 |
| North CarolinaNorth Carolina | $527.72 | $83.96 |
| North DakotaNorth Dakota | $559.51 | $83.88 |
| NebraskaNebraska | $521.00 | $81.99 |
| New HampshireNew Hampshire | $583.04 | $87.91 |
| Northern New JerseyNew Jersey | $647.28 | $95.55 |
| Rest of New JerseyNew Jersey | $612.27 | $92.89 |
| New MexicoNew Mexico | $523.51 | $87.36 |
| NevadaNevada | $562.86 | $86.75 |
| NYC suburbs and Long Island, NYNew York | $667.04 | $101.52 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $614.82 | $94.00 |
| Queens, NYNew York | $660.79 | $98.59 |
| Rest of New YorkNew York | $536.61 | $84.76 |
| OhioOhio | $520.23 | $85.98 |
| OklahomaOklahoma | $508.73 | $84.00 |
| Portland, OROregon | $617.95 | $89.53 |
| Rest of OregonOregon | $559.50 | $85.77 |
| Metropolitan Philadelphia, PAPennsylvania | $586.23 | $91.10 |
| Rest of PennsylvaniaPennsylvania | $522.30 | $85.67 |
| Puerto RicoPuerto Rico | $568.85 | $87.99 |
| Rhode IslandRhode Island | $580.30 | $88.97 |
| South CarolinaSouth Carolina | $524.65 | $85.17 |
| South DakotaSouth Dakota | $559.04 | $83.41 |
| TennesseeTennessee | $515.09 | $82.75 |
| Austin, TXTexas | $591.69 | $88.48 |
| Beaumont, TXTexas | $518.21 | $85.39 |
| Brazoria, TXTexas | $558.00 | $86.65 |
| Dallas, TXTexas | $561.07 | $87.34 |
| Fort Worth, TXTexas | $556.18 | $87.21 |
| Galveston, TXTexas | $559.31 | $87.01 |
| Houston, TXTexas | $562.97 | $90.67 |
| Rest of TexasTexas | $537.44 | $86.07 |
| UtahUtah | $532.93 | $85.84 |
| VirginiaVirginia | $553.05 | $85.51 |
| VermontVermont | $555.20 | $84.32 |
| Rest of WashingtonWashington | $589.02 | $88.18 |
| King County, WAWashington | $678.18 | $94.58 |
| WisconsinWisconsin | $537.95 | $82.30 |
| West VirginiaWest Virginia | $501.16 | $87.84 |
| WyomingWyoming | $561.74 | $86.11 |
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.
The exact Virgin Islands, VI inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,922
- Code
- 50435
- Physician work
- 1.77
- Practice expense
- 14.90
- Malpractice
- 0.20
GPCI2026.csv
107
- Locality
- Virgin Islands, VI
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.77 | × 1.000 | 1.7700 |
| Practice expense | 14.90 | × 1.011 | 15.0639 |
| Malpractice | 0.20 | × 0.985 | 0.1970 |
| Total RVUs | 17.0309 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Virgin Islands, VI$568.85
Office: (1.77 × 1 + 14.9 × 1.011 + 0.2 × 0.985) × $33.4009 = $568.85
Facility: (1.77 × 1 + 0.66 × 1.011 + 0.2 × 0.985) × $33.4009 = $87.99
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).
How 50435 has changed in Virgin Islands, VI
50435 · Office / nonfacility
$568.85
Effective 2026-10-01
The base rate is $12.74 higher than on 2025-10-01, moving from $556.11 to $568.85 (2.3%).
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
$556.11changed to$568.85
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.82 changed to 1.77
- Practice expense RVU 15.09 changed to 14.90
- Malpractice RVU 0.18 changed to 0.20
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$589.38changed to$556.11
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 15.59 changed to 15.09
- Malpractice RVU 0.19 changed to 0.18
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$579.76changed to$589.38
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$620.69changed to$579.76
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 16.18 changed to 15.59
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$616.41changed to$620.69
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$651.32changed to$616.41
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 16.69 changed to 16.18
- Malpractice RVU 0.18 changed to 0.19
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$638.10changed to$651.32
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 16.19 changed to 16.69
- Malpractice RVU 0.15 changed to 0.18
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$582.51changed to$638.10
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 14.06 changed to 16.19
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$530.39changed to$582.51
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 12.65 changed to 14.06
- Malpractice RVU 0.16 changed to 0.15
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$485.94changed to$530.39
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 11.44 changed to 12.65
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$482.97changed to$485.94
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 11.41 changed to 11.44
- Practice expense GPCI 1.006 changed to 1.007
- Malpractice GPCI 0.993 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$464.43changed to$482.97
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 11.45 changed to 11.41
- Practice expense GPCI 0.960 changed to 1.006
- Malpractice GPCI 0.996 changed to 0.993
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
No ratechanged to$464.43
Held through RVU16B, RVU16C, RVU16D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $568.85 | $87.99 | RVU26D |
| 2026-07-01 | $568.85 | $87.99 | RVU26C |
| 2026-04-01 | $568.85 | $87.99 | RVU26B |
| 2026-01-01 | $568.85 | $87.99 | RVU26A |
| 2025-10-01 | $556.11 | $95.21 | RVU25D |
| 2025-07-01 | $556.11 | $95.21 | RVU25C |
| 2025-04-01 | $556.11 | $95.21 | RVU25B |
| 2025-01-01 | $556.11 | $95.21 | RVU25A |
| 2024-10-01 | $589.38 | $97.30 | RVU24D |
| 2024-07-01 | $589.38 | $97.30 | RVU24C |
| 2024-04-01 | $589.38 | $97.30 | RVU24B |
| 2024-03-09 | $589.38 | $97.30 | RVU24AR |
| 2024-01-01 | $579.76 | $95.71 | RVU24A |
| 2023-10-01 | $620.69 | $99.09 | RVU23D |
| 2023-07-01 | $616.41 | $98.95 | RVU23C |
| 2023-04-01 | $616.41 | $98.95 | RVU23B |
| 2023-01-01 | $616.41 | $98.95 | RVU23A |
| 2022-10-01 | $651.32 | $100.17 | RVU22D |
| 2022-07-01 | $651.32 | $100.17 | RVU22C |
| 2022-04-01 | $651.32 | $100.17 | RVU22B |
| 2022-01-01 | $651.32 | $100.17 | RVU22A |
| 2021-10-01 | $638.10 | $99.97 | RVU21D |
| 2021-07-01 | $638.10 | $99.97 | RVU21C |
| 2021-04-01 | $638.10 | $99.97 | RVU21B |
| 2021-01-01 | $638.10 | $99.97 | RVU21A |
| 2020-10-01 | $582.51 | $104.14 | RVU20D |
| 2020-07-01 | $582.51 | $104.14 | RVU20C |
| 2020-04-01 | $582.51 | $104.14 | RVU20B |
| 2020-01-01 | $582.51 | $104.14 | RVU20A |
| 2019-10-01 | $530.39 | $104.69 | RVU19D |
| 2019-07-01 | $530.39 | $104.69 | RVU19C |
| 2019-04-01 | $530.39 | $104.69 | RVU19B |
| 2019-01-01 | $530.39 | $104.69 | RVU19A |
| 2018-10-01 | $485.94 | $104.94 | RVU18D |
| 2018-07-01 | $485.94 | $104.94 | RVU18C |
| 2018-04-01 | $485.94 | $104.94 | RVU18B |
| 2018-01-01 | $485.94 | $104.94 | RVU18AR1 |
| 2017-10-01 | $482.97 | $105.32 | RVU17D |
| 2017-07-01 | $482.97 | $105.32 | RVU17C |
| 2017-04-01 | $482.97 | $105.32 | RVU17B |
| 2017-01-01 | $482.97 | $105.32 | RVU17A |
| 2016-10-01 | $464.43 | $103.87 | RVU16D |
| 2016-07-01 | $464.43 | $103.87 | RVU16C |
| 2016-04-01 | $464.43 | $103.87 | RVU16B |
| 2016-01-01 | $464.43 | $103.87 | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Virgin Islands, VI rate applies
Virgin Islands, VI is a Medicare payment area, not a city. Our Census mapping connects it to 10 cities and communities in United States Virgin Islands. Some span more than one payment area; confirm with the service ZIP.
- Charlotte Amalie
- Charlotte Amalie East
- Charlotte Amalie West
- Christiansted
- Coral Bay
- Cruz Bay
- Frederiksted
- Frederiksted Southeast
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
Show the CMS file lines behind this rate
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