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Billing code 49421: Dialysis catheter placementMedicare rate & RVUs

Report this service when a surgeon uses an open approach to place a tunneled catheter into the abdomen for peritoneal dialysis.

CMS RVU26DEffective Oct 1, 2026109 payment localities702 Medicare services in 2024

Medicare pays $206.75 for 49421 nationally in a facility.

Medicare rate · 49421

Dialysis catheter placement

Work RVUs
4.1
Total RVUs
6.19
Global days
000

National rate · 2026

$206.75

Facility setting, before claim adjustments.

See every locality for 49421 →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 49421 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 49421 covers

This procedure establishes access for peritoneal dialysis, often for a patient preparing to begin home dialysis. A surgeon makes an incision to place the catheter into the peritoneal cavity and routes part of it through a tunnel beneath the skin. The procedure is commonly performed in an operating room. The open approach, rather than the need for dialysis alone, distinguishes this service from percutaneous catheter placement.

Report 49421 when the operative note supports open insertion, intraperitoneal catheter placement, and creation of the subcutaneous tunnel. A catheter placed percutaneously or one connected to an implanted subcutaneous port calls for a different code. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. CMS does not pay an assistant at surgery for this code and does not permit co-surgeons or team surgery.

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 49421 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

49421 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$187.40
Alaska*Unavailable$262.08
ArizonaUnavailable$200.70
ArkansasUnavailable$185.07
AtlantaUnavailable$214.64
AustinUnavailable$205.16
BakersfieldUnavailable$199.30
Baltimore/Surr. CntysUnavailable$219.68
BeaumontUnavailable$201.12
BrazoriaUnavailable$199.96

49421 rates by state

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

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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
49421 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 49421 rate is calculated

Each of 49421’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 · 49421

RVUs × geographic indexes × conversion factor

Work4.10

4.10 RVUs× 1.000 GPCI

Practice expense1.06

1.06 RVUs× 1.000 GPCI

Malpractice1.03

1.03 RVUs× 1.000 GPCI

Adjusted RVUs

6.1900

Conversion factor

$33.4009

Medicare rate

$206.75

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

Payment rules and modifiers for 49421

The CMS indicators that decide how 49421 is paid alongside other services.

CMS payment indicators · 49421

Dialysis catheter placement

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)0The 150% bilateral adjustment doesn’t apply.
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 51 · payment effect

With and without the modifier

49421 without 51 · national facility

$206.75

Dialysis catheter placement

49421-51 · Second procedure: 50%

$103.38

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%).

When to use modifier 51

49421 compared with similar codes

Compare codes · National

4 codes, side by side

  • 49421

    Dialysis catheter placement4.1 wRVU

    Not priced

  • 49418

    Peritoneal catheter3.86 wRVU

    $939.57

  • 49419

    Peritoneal catheter6.9 wRVU

    Not priced

  • 49435

    Catheter extension2.19 wRVU

    Not priced

How to choose

49418Peritoneal catheter
Both establish tunneled intraperitoneal catheter access. Choose 49421 for open surgical insertion and 49418 for percutaneous insertion.
49419Peritoneal catheter
Choose 49419 when placement includes an implanted subcutaneous port. A catheter tunneled beneath the skin without a port is not enough to select 49419.
49435Catheter extension
49421 covers open placement of the tunneled intraperitoneal catheter, including its tunnel. Code 49435 addresses insertion of a separate subcutaneous extension, not routine tunneling.

Codes related to 49421

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

Codes related to 49421
CodeHow it relatesNational office range
Used instead
49418Peritoneal catheterPercutaneous placement of a tunneled intraperitoneal dialysis catheter instead of open insertion.$820.21–$1,298.74
49419Peritoneal catheterPlacement of a tunneled intraperitoneal catheter with an implanted subcutaneous port.No office rate
Add-on codes
49435Catheter extensionSeparately inserted subcutaneous extension to an intraperitoneal catheter.No office rate

49421 billing questions

How is 49421 distinguished from 49418?

Use 49421 when the surgeon places the tunneled intraperitoneal dialysis catheter through an open incision. Code 49418 describes percutaneous insertion.

What if the catheter has an implanted subcutaneous port?

Consider 49419 for insertion of a tunneled intraperitoneal catheter with a subcutaneous port. Documenting a subcutaneous tunnel alone does not establish that a port was implanted.

Is routine care before and after placement separately reported on the procedure date?

The 0-day global period includes same-day preoperative and postoperative care for the open catheter placement.

How does Medicare pay 49421 with another procedure in the same session?

The standard multiple procedure reduction applies: the highest-valued procedure is paid in full and the others at 50%.

Can modifier 50 or a surgical assistant be reported for 49421?

Modifier 50 is inappropriate for this catheter placement. CMS does not pay an assistant at surgery for 49421 and does not permit co-surgeons or team surgery.

Is the subcutaneous tunnel itself reported with 49435?

No. Tunneling is part of the placement described by 49421; 49435 concerns a separately inserted subcutaneous catheter extension.

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 49421PPRRVU2026_Oct_nonQPP.csv, line 5,801 (RVU26D)

Open CMS sourceHow we calculate rates

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