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Billing code 49435: Catheter extensionMedicare rate & RVUs

Reports tunneling and placement of a subcutaneous extension on an intraperitoneal dialysis catheter, such as to create a presternal exit site.

CMS RVU26DEffective Oct 1, 2026109 payment localities294 Medicare services in 2024

Medicare pays $105.88 for 49435 nationally in a facility.

Medicare rate · 49435

Catheter extension

Swap in your local Medicare rate.

Work RVUs
2.19
Total RVUs
3.17
Global days
ZZZ

National rate · 2026

$105.88

Facility setting, before claim adjustments.

See every locality for 49435 → · 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 49435 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 49435 covers

This service adds a subcutaneous segment to an intraperitoneal catheter and tunnels it to a new exit site, such as the chest for a presternal configuration. It is performed by a surgeon or another clinician who places peritoneal dialysis access, typically in an operative setting. The extension changes where the catheter exits the skin; it is not a service for inserting an entirely new intraperitoneal catheter.

Report 49435 as an add-on with the qualifying open catheter insertion, 49421. The record should identify the existing or concurrently placed catheter, the extension, the tunneling performed, and the intended exit-site location. Do not report it alone or pair it with a different primary insertion code. CMS pays this add-on within the global period of the primary procedure, so it is included in that procedure’s global-period payment.

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 49435 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

49435 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$95.91
Alaska*Unavailable$134.80
ArizonaUnavailable$102.71
ArkansasUnavailable$94.72
AtlantaUnavailable$110.15
AustinUnavailable$104.65
BakersfieldUnavailable$101.14
Baltimore/Surr. CntysUnavailable$112.56
BeaumontUnavailable$103.30
BrazoriaUnavailable$102.15

49435 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

View every state and territory as a table
49435 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 49435 rate is calculated

Each of 49435’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 · 49435

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 2.19Practice expense 0.41Malpractice 0.57

3.1700 adjusted RVUs×$33.4009 conversion factor=$105.88

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

Payment rules and modifiers for 49435

The CMS indicators that decide how 49435 is paid alongside other services.

CMS payment indicators · 49435

Catheter extension

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
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.

What modifiers do to the payment

Modifier 80 · payment effect

With and without the modifier

49435 without 80 · national facility

$105.88

Catheter extension

49435-80 · Assistant: 16%

$16.94

A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.

When to use modifier 80

49435 compared with similar codes

Compare codes

49435 vs 49421 vs 49418 vs 49436: national Medicare rates

Swap in your local Medicare rate.

  • 49435
    Catheter extension · 2.19 wRVU
    —
  • 49421
    Dialysis catheter placement · 4.1 wRVU
    —
  • 49418
    Peritoneal catheter · 3.86 wRVU
    $939.57
  • 49436
    Catheter revision · 2.65 wRVU
    $562.47

How to choose

49421Dialysis catheter placement
49421 reports open insertion of the tunneled intraperitoneal catheter; 49435 adds the subcutaneous extension and is reported with that primary procedure.
49418Peritoneal catheter
49418 reports percutaneous insertion of a tunneled intraperitoneal catheter. 49435 is an extension add-on paired with 49421, not a substitute for the percutaneous insertion code.
49436Catheter revision
49436 addresses externalizing a previously implanted buried catheter. Use 49435 for adding and tunneling a subcutaneous extension.

Codes related to 49435

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

Codes related to 49435
CodeHow it relatesNational office range
Primary code
49421Dialysis catheter placementQualifying open tunneled intraperitoneal catheter insertion reported with this extension add-on.No office rate
Used instead
49436Catheter revisionExternalizes a previously implanted buried catheter rather than adding this extension.$487.83–$761.12

49435 billing questions

Which primary code is paired with 49435?

Report 49435 with 49421 for open insertion of a tunneled intraperitoneal dialysis catheter. It is not a stand-alone code.

When is an extension distinct from catheter insertion?

49435 describes adding and tunneling a subcutaneous segment to create a different exit site, such as a presternal site. It does not describe placing the intraperitoneal catheter itself.

What documentation supports 49435?

Document the catheter involved, the subcutaneous extension and tunneling, and the resulting exit-site location. The record should also support the qualifying 49421 primary procedure.

Is 49435 paid separately during the global period?

CMS identifies 49435 as an add-on paid within the primary procedure’s global period. Report it with 49421 rather than as a separate stand-alone service.

Can 49435 be used when a buried catheter is brought out through the skin?

That circumstance is described by 49436, which addresses externalizing a previously implanted catheter. 49435 is for adding a subcutaneous 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 49435PPRRVU2026_Oct_nonQPP.csv, line 5,810 (RVU26D)

Open CMS sourceHow we calculate rates

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