Billing code 50435: Nephrostomy exchangeMedicare rate & RVUs in Florida
Report this service when a clinician exchanges an existing percutaneous nephrostomy catheter through its established renal access tract, with imaging guidance.
Medicare pays $544.94–$594.09 for 50435 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 9 sections
What 50435 covers
An interventional radiologist or urologist exchanges a nephrostomy catheter through the patient’s established percutaneous tract into the renal collecting system. The service is used for routine catheter maintenance or when an existing tube is obstructed, damaged, or no longer functioning adequately. Imaging guides the exchange; contrast evaluation of the collecting system or ureter may be performed as part of the service. It is commonly furnished in a hospital or outpatient imaging setting.
Document the existing access, the catheter exchange, the treated side, and the imaging guidance used. When performed during the exchange, the diagnostic nephrostogram or ureterogram and associated imaging are included. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. With modifier 50, a bilateral procedure is paid at 150%. Assistant-at-surgery payment is restricted; 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 50435 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$544.94 to $594.09
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $575.34 | $93.53 |
| Miami | $594.09 | $98.96 |
| Rest Of Florida | $544.94 | $90.23 |
How the 50435 rate is calculated
Each of 50435’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 · 50435
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.77Practice expense 14.90Malpractice 0.20
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 50435
The CMS indicators that decide how 50435 is paid alongside other services.
CMS payment indicators · 50435
Nephrostomy exchange
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
50435 without 50 · national office
$563.47
Nephrostomy exchange
50435-50 · Bilateral: 150%
$845.21
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).
50435 compared with similar codes
Compare codes
50435 vs 50432 vs 50434 vs 50430: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 50432Nephrostomy placement
- 50435 exchanges a catheter through an existing percutaneous access tract. 50432 is for placing a nephrostomy catheter through new access.
- 50434Catheter conversion
- Choose 50434 for conversion of a nephrostomy catheter to a nephroureteral catheter; choose 50435 for exchange of a nephrostomy catheter.
- 50430Antegrade nephrostogram
- 50430 describes an antegrade nephrostogram or ureterogram through existing access. During a 50435 exchange, that diagnostic imaging is included when performed.
50435 billing questions
How is an exchange different from placing a nephrostomy catheter?
Use 50435 when the clinician exchanges a catheter through an existing percutaneous renal access tract. Placement through new access is represented by 50432.
Can the nephrostogram be billed separately during the exchange?
No. The diagnostic nephrostogram or ureterogram, when performed as part of the exchange, is included in 50435.
When is 50434 more appropriate?
Use 50434 when the existing nephrostomy catheter is converted to a nephroureteral catheter, rather than exchanged for another nephrostomy catheter.
How should bilateral exchanges be reported?
CMS identifies 50435 as a bilateral procedure; report modifier 50 when both sides are treated. The bilateral payment is 150%.
What same-session payment reduction may apply?
When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and the others at 50%.
What documentation supports reporting 50435?
Record that a nephrostomy catheter was already present, that it was exchanged through the existing access, the side treated, and the imaging guidance used.
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
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