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Billing code 34421: Venous thrombectomyMedicare rate & RVUs

Reports open removal of thrombus from the vena cava through an abdominal incision, using direct extraction or catheter-assisted removal.

CMS RVU26DEffective Oct 1, 2026109 payment localities60 Medicare services in 2024

Medicare pays $635.29 for 34421 nationally in a facility.

Medicare rate · 34421

Venous thrombectomy

Swap in your local Medicare rate.

Work RVUs
13.04
Total RVUs
19.02
Global days
090

National rate · 2026

$635.29

Facility setting, before claim adjustments.

See every locality for 34421 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 34421 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 34421 covers

This operation removes clot from the vena cava through an abdominal incision, either by direct extraction or with catheter assistance. It is generally performed by a vascular surgeon or another surgeon experienced in major venous procedures in a hospital operating room. The service is distinct from clot removal in the iliac or leg veins because the target is the vena cava and access is abdominal.

Report the code when the operative record supports vena cava thrombectomy by this approach; document the treated vessel, incision, and method of clot removal. It has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires 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.

Where 34421 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

34421 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$576.05
Alaska*Unavailable$809.04
ArizonaUnavailable$616.56
ArkansasUnavailable$568.98
AtlantaUnavailable$660.30
AustinUnavailable$628.67
BakersfieldUnavailable$608.73
Baltimore/Surr. CntysUnavailable$675.02
BeaumontUnavailable$619.42
BrazoriaUnavailable$613.57

34421 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
34421 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 34421 rate is calculated

Each of 34421’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 · 34421

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.04Practice expense 2.66Malpractice 3.32

19.0200 adjusted RVUs×$33.4009 conversion factor=$635.29

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 34421

34421 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 34421

Venous thrombectomy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are 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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 34421

Venous thrombectomy

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

34421 without 50 · national facility

$635.29

Venous thrombectomy

34421-50 · Bilateral: 150%

$952.94

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

34421 compared with similar codes

Compare codes

34421 vs 34401 vs 34451 vs 34471: national Medicare rates

Swap in your local Medicare rate.

  • 34421
    Venous thrombectomy · 13.04 wRVU
    —
  • 34401
    Vein thrombectomy · 25.86 wRVU
    —
  • 34451
    Venous thrombectomy · 27.81 wRVU
    —
  • 34471
    Venous thrombectomy · 20.58 wRVU
    —

How to choose

34401Vein thrombectomy
This code targets the vena cava through an abdominal incision; 34401 is for iliac-vein thrombectomy.
34451Venous thrombectomy
This code treats the vena cava through an abdominal approach; 34451 addresses femoral-vein thrombectomy through a leg approach.
34471Venous thrombectomy
This code treats the vena cava through an abdominal approach; 34471 addresses popliteal-vein thrombectomy through a leg approach.

Codes related to 34421

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 34421
CodeHow it relatesNational office range
Same family
34401Vein thrombectomyRelated open venous thrombectomy code for iliac-vein clot removal.No office rate
34451Venous thrombectomyRelated code for thrombectomy of the femoral vein through a leg approach.No office rate
34471Venous thrombectomyRelated code for thrombectomy of the popliteal vein through a leg approach.No office rate

34421 billing questions

How is this distinguished from iliac vein thrombectomy?

Use this code when the vena cava is the vessel treated through an abdominal incision. Iliac-vein thrombectomy is a different anatomic service.

What operative details support reporting?

The record should identify the vena cava as the treated vessel and describe the abdominal approach and direct or catheter-assisted clot removal.

Does the code include postoperative care?

Its 90-day global period includes the day-before preoperative visit and related postoperative care during the global period.

Can an assistant surgeon be reported?

Assistant-at-surgery payment may be available for this procedure. Co-surgeon payment requires supporting documentation.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, with other procedures subject to the standard multiple-procedure reduction.

How is bilateral performance handled?

When the procedure is bilateral, modifier 50 is paid at 150% under the CMS rule for this code.

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 34421PPRRVU2026_Oct_nonQPP.csv, line 4,189 (RVU26D)

Open CMS sourceHow we calculate rates

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