No office rate
Choose 49425 when inserting a new peritoneovenous shunt. Choose 49427 when injecting and assessing a shunt that is already present.
On this page
CMS RVU26D · Effective 2026-10-01
49427 Shunt injection Medicare reimbursement rates in Alabama
Reports injection of an existing peritoneovenous shunt to evaluate its function, commonly when a patient with ascites has suspected shunt obstruction or malfunction. Compare 49427 office and facility rates across CMS payment localities in Alabama.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 49427 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$33.48
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Abdominal shunt procedure
About 49427: Peritoneovenous shunt injection and assessment
Reports injection of an existing peritoneovenous shunt to evaluate its function, commonly when a patient with ascites has suspected shunt obstruction or malfunction.
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.
CMS billing rules for 49427
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.87 · 82%
- Practice expense (office) RVU0.08 · 8%
- Malpractice RVU0.11 · 10%
29
Medicare services in 2024 · #5689 by national volume
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.
49427 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
Choose 49426 for operative revision of the shunt. Choose 49427 for injection and evaluation without shunt revision.
No office rate
49428 describes ligating the shunt; 49427 describes injecting it to assess function.
No office rate
49429 describes shunt removal. It is not the code for injection and assessment of a shunt that remains in place.
Compare 49427 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$33.48
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 49427 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
5,807
- Code
- 49427
- Physician work
- 0.87
- Practice expense
- 0.08
- Malpractice
- 0.11
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.87 | × 1.000 | 0.8700 |
| Practice expense | 0.08 | × 0.875 | 0.0700 |
| Malpractice | 0.11 | × 0.566 | 0.0623 |
| Total RVUs | 1.0023 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$33.48
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.87 | 1 |
| Practice expense | 0.08 | 0.875 |
| Malpractice | 0.11 | 0.566 |
(0.87 × 1 + 0.08 × 0.875 + 0.11 × 0.566) × $33.4009 = $33.48
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,80449424,,Assess cyst contrast inject,A,,0.74,4.31,,0.15,,0.07,5.12,0.96,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,80549425,,Insert abdomen-venous drain,A,,11.91,7.26,NA,7.26,,3.18,22.35,22.35,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,80649426,,Revise abdomen-venous shunt,A,,10.15,6.38,NA,6.38,,2.71,19.24,19.24,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,80749427,,Injection abdominal shunt,A,,0.87,0.08,NA,0.08,,0.11,1.06,1.06,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,80849428,,Ligation of shunt,A,,6.70,3.84,NA,3.84,,1.78,12.32,12.32,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,80949429,,Removal of shunt,A,,7.25,3.82,NA,3.82,,1.94,13.01,13.01,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,81049435,,Insert subq exten to ip cath,A,,2.19,0.41,NA,0.41,,0.57,3.17,3.17,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515