$863.05
Both establish tunneled intraperitoneal catheter access. Choose 49421 for open surgical insertion and 49418 for percutaneous insertion.
On this page
CMS RVU26D · Effective 2026-10-01
49421 Dialysis catheter placement Medicare reimbursement rates in Iowa
Report this service when a surgeon uses an open approach to place a tunneled catheter into the abdomen for peritoneal dialysis. Compare 49421 office and facility rates across CMS payment localities in Iowa.
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 49421 in Iowa?
Iowa 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
$183.00
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Peritoneal dialysis access
About 49421: Open placement of tunneled peritoneal dialysis catheter
Report this service when a surgeon uses an open approach to place a tunneled catheter into the abdomen for peritoneal dialysis.
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.
CMS billing rules for 49421
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.10 · 66%
- Practice expense (office) RVU1.06 · 17%
- Malpractice RVU1.03 · 17%
702
Medicare services in 2024 · #3259 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.
49421 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
Choose 49419 when placement includes an implanted subcutaneous port. A catheter tunneled beneath the skin without a port is not enough to select 49419.
No office rate
49421 covers open placement of the tunneled intraperitoneal catheter, including its tunnel. Code 49435 addresses insertion of a separate subcutaneous extension, not routine tunneling.
Compare 49421 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
Iowa →
Office / nonfacility
Unavailable
Facility
$183.00
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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 49421 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,801
- Code
- 49421
- Physician work
- 4.10
- Practice expense
- 1.06
- Malpractice
- 1.03
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.10 | × 1.000 | 4.1000 |
| Practice expense | 1.06 | × 0.915 | 0.9699 |
| Malpractice | 1.03 | × 0.397 | 0.4089 |
| Total RVUs | 5.4788 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$183.00
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.1 | 1 |
| Practice expense | 1.06 | 0.915 |
| Malpractice | 1.03 | 0.397 |
(4.1 × 1 + 1.06 × 0.915 + 1.03 × 0.397) × $33.4009 = $183.00
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.
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 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.
5,79849412,,Ins device for rt guide open,A,,1.46,0.36,NA,0.36,,0.39,2.21,2.21,0,ZZZ,0.00,0.00,0.00,0,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,79949418,,Insert tun ip cath perc,A,,3.86,23.83,,0.93,,0.44,28.13,5.23,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,80049419,,Insert tun ip cath w/port,A,,6.90,3.23,NA,3.23,,1.59,11.72,11.72,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,80149421,,Ins tun ip cath for dial opn,A,,4.10,1.06,NA,1.06,,1.03,6.19,6.19,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,80249422,,Remove tunneled ip cath,A,,3.90,1.18,NA,1.18,,0.96,6.04,6.04,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,80349423,,Exchange drainage catheter,A,,1.42,14.87,,0.24,,0.16,16.45,1.82,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,80449424,,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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136