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Billing code 49427: Shunt injectionMedicare rate & RVUs

Reports injection of an existing peritoneovenous shunt to evaluate its function, commonly when a patient with ascites has suspected shunt obstruction or malfunction.

CMS RVU26DEffective Oct 1, 2026109 payment localities29 Medicare services in 2024

Medicare pays $35.40 for 49427 nationally in a facility.

Medicare rate · 49427

Shunt injection

Swap in your local Medicare rate.

Work RVUs
0.87
Total RVUs
1.06
Global days
000

National rate · 2026

$35.40

Facility setting, before claim adjustments.

See every locality for 49427 → · 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 49427 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 49427 covers

This service evaluates an existing peritoneovenous shunt, such as a LeVeen shunt, by injecting contrast into the shunt and assessing its flow. It may be performed by an interventional radiologist or surgeon for a patient with ascites when clinical findings raise concern about shunt patency or function. The procedure is distinct from placing, revising, ligating, or removing the shunt.

Report 49427 for the injection and assessment, supported by documentation identifying the shunt, the reason for evaluation, the access and injection performed, and the findings. The CMS global period is 0 days, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Bilateral adjustment is inappropriate for this service. Assistant-at-surgery payment requires documentation of medical necessity; 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 49427 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

49427 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$33.48
Alaska*Unavailable$48.46
ArizonaUnavailable$34.79
ArkansasUnavailable$33.25
AtlantaUnavailable$36.27
AustinUnavailable$35.20
BakersfieldUnavailable$34.78
Baltimore/Surr. CntysUnavailable$36.94
BeaumontUnavailable$34.90
BrazoriaUnavailable$34.81

49427 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
49427 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 49427 rate is calculated

Each of 49427’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 · 49427

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 0.87Practice expense 0.08Malpractice 0.11

1.0600 adjusted RVUs×$33.4009 conversion factor=$35.40

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

Payment rules and modifiers for 49427

The CMS indicators that decide how 49427 is paid alongside other services.

CMS payment indicators · 49427

Shunt injection

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)0Not paid without supporting documentation.
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

49427 without 51 · national facility

$35.40

Shunt injection

49427-51 · Second procedure: 50%

$17.70

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

49427 compared with similar codes

Compare codes

49427 vs 49425 vs 49426 vs 49428 vs 49429: national Medicare rates

Swap in your local Medicare rate.

  • 49427
    Shunt injection · 0.87 wRVU
    —
  • 49425
    Abdominal shunt · 11.91 wRVU
    —
  • 49426
    Shunt revision · 10.15 wRVU
    —
  • 49428
    Shunt ligation · 6.7 wRVU
    —
  • 49429
    Shunt removal · 7.25 wRVU
    —

How to choose

49425Abdominal shunt
Choose 49425 when inserting a new peritoneovenous shunt. Choose 49427 when injecting and assessing a shunt that is already present.
49426Shunt revision
Choose 49426 for operative revision of the shunt. Choose 49427 for injection and evaluation without shunt revision.
49428Shunt ligation
49428 describes ligating the shunt; 49427 describes injecting it to assess function.
49429Shunt removal
49429 describes shunt removal. It is not the code for injection and assessment of a shunt that remains in place.

Codes related to 49427

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

Codes related to 49427
CodeHow it relatesNational office range
Same family
49425Abdominal shuntPlaces a peritoneovenous shunt; 49427 evaluates an existing shunt.No office rate
49426Shunt revisionRevises a peritoneovenous shunt rather than evaluating it by injection.No office rate
49428Shunt ligationLigation of a peritoneovenous shunt.No office rate
49429Shunt removalRemoval of a peritoneovenous shunt.No office rate

49427 billing questions

When should 49427 be selected instead of 49426?

Use 49427 for injection and assessment of an existing shunt. Use 49426 when the shunt itself is revised.

Is 49427 used to place a new peritoneovenous shunt?

No. Placement is reported with 49425; 49427 describes injection and assessment of an existing shunt.

Can 49427 be reported with shunt revision during the same session?

If injection and assessment are performed along with a revision, document the distinct work and follow applicable coding edits. CMS applies the standard multiple procedure reduction when multiple procedures are performed in the same session.

Does 49427 have a global period?

It has a 0-day global period. Same-day preoperative and postoperative care is included.

Can modifier 50 be used for 49427?

No. Bilateral adjustment is inappropriate for this service.

When is assistant-at-surgery payment allowed?

CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted.

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 49427PPRRVU2026_Oct_nonQPP.csv, line 5,807 (RVU26D)

Open CMS sourceHow we calculate rates

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