No office rate
Choose 49426 when the shunt is revised and remains in use. Choose 49428 when the operation closes the shunt to stop flow.
On this page
CMS RVU26D · Effective 2026-10-01
49428 Shunt ligation Medicare reimbursement rates in Kansas
Ligation of a peritoneovenous shunt permanently closes the channel carrying ascitic fluid into venous circulation when the shunt is taken out of service. Compare 49428 office and facility rates across CMS payment localities in Kansas.
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 49428 in Kansas?
Kansas 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
$369.70
1 of 1 localities have a supported rate.
Payment area: Kansas
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.
Surgical procedure
About 49428: Peritoneovenous shunt ligation
Ligation of a peritoneovenous shunt permanently closes the channel carrying ascitic fluid into venous circulation when the shunt is taken out of service.
This procedure closes a peritoneovenous shunt that carries fluid from the peritoneal cavity into the venous system. A surgeon performs it to stop shunt flow, such as when the device is no longer intended to function. It is distinct from revising a shunt that will remain in use or removing the device itself. The service is generally performed in a surgical setting.
Report 49428 when the operative work is ligation, rather than shunt revision or removal. The operative note should identify the peritoneovenous shunt and document that it was surgically closed. Medicare includes related postoperative visits during the 10-day global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Do not append modifier 50; the shunt anatomy and descriptor are not billed as bilateral. Medicare does not pay an assistant-at-surgery claim under the statutory restriction, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 49428
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are 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 RVU6.70 · 54%
- Practice expense (office) RVU3.84 · 31%
- Malpractice RVU1.78 · 14%
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.
49428 compared with similar codes
Office rates for Kansas, from the same CMS release.
No office rate
49427 describes injection of an abdominal venous shunt, not its surgical closure.
No office rate
49429 is for removing the shunt; 49428 closes it by ligation while leaving it in place.
No office rate
49425 is for placing an abdominal venous shunt, whereas 49428 closes an existing peritoneovenous shunt.
Compare 49428 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
Kansas →
Office / nonfacility
Unavailable
Facility
$369.70
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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 49428 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
5,808
- Code
- 49428
- Physician work
- 6.70
- Practice expense
- 3.84
- Malpractice
- 1.78
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.70 | × 1.000 | 6.7000 |
| Practice expense | 3.84 | × 0.904 | 3.4714 |
| Malpractice | 1.78 | × 0.504 | 0.8971 |
| Total RVUs | 11.0685 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kansas$369.70
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.7 | 1 |
| Practice expense | 3.84 | 0.904 |
| Malpractice | 1.78 | 0.504 |
(6.7 × 1 + 3.84 × 0.904 + 1.78 × 0.504) × $33.4009 = $369.70
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.
49428 billing questions
How is ligation different from shunt removal?
49428 is for surgically closing the shunt while it remains in place. Report 49429 when the shunt is removed.
When should 49428 be chosen over shunt revision?
Use 49428 when the operative intent is to stop shunt flow by ligating it. Use 49426 when the shunt is revised rather than taken out of service.
What should the operative note document?
Document that the device is a peritoneovenous shunt and that the surgeon ligated it to stop flow. The note should make clear whether the shunt was closed, revised, or removed.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard multiple-procedure reduction.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this shunt procedure. Medicare does not pay an assistant-at-surgery claim; 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.
5,80549425,,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
5,81149436,,Embedded ip cath exit-site,A,,2.65,13.51,,1.99,,0.68,16.84,5.32,0,010,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958