No office rate
49425 is for initial peritoneovenous shunt placement. Choose 49426 when the surgeon revises a shunt that is already present.
On this page
CMS RVU26D · Effective 2026-10-01
49426 Shunt revision Medicare reimbursement rates in Massachusetts
Report revision of an existing peritoneovenous shunt when surgery is performed to correct a problem with the shunt used to manage ascites. Compare 49426 office and facility rates across CMS payment localities in Massachusetts.
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 49426 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$640.98–$687.92
2 of 2 localities have a supported rate.
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 surgery
About 49426: Peritoneovenous shunt revision
Report revision of an existing peritoneovenous shunt when surgery is performed to correct a problem with the shunt used to manage ascites.
This service revises an existing peritoneovenous shunt, which carries fluid from the abdominal cavity into the venous circulation. Surgeons may perform the operation when a shunt requires correction to restore function or address a mechanical problem. The service is generally performed in a hospital or other surgical facility; CMS records show facility services for this code and no office services in 2024.
Report 49426 for revision of an existing shunt, not its initial placement, evaluation by injection, ligation, or removal. The operative report should identify the shunt and describe the revision performed and the reason it was needed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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. Modifier 50 is inappropriate. Assistant-at-surgery services are not paid under the statutory restriction; co-surgeons and team surgery are not permitted.
CMS billing rules for 49426
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 RVU10.15 · 53%
- Practice expense (office) RVU6.38 · 33%
- Malpractice RVU2.71 · 14%
24
Medicare services in 2024 · #5817 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.
49426 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
49427 covers injection to evaluate a peritoneovenous shunt; it is not the surgical revision service reported with 49426.
No office rate
49428 is for ligating the shunt. Report 49426 when the procedure revises the shunt rather than ligating it.
No office rate
49429 is for removing the shunt. Use 49426 when the shunt is revised and remains in place.
Compare 49426 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$687.92
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$640.98
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49426 billing questions
When should 49426 be used instead of 49425?
Use 49426 when the operation revises a peritoneovenous shunt already in place. Use 49425 for initial shunt placement.
Does shunt evaluation by injection count as revision?
No. 49427 describes injection to evaluate a peritoneovenous shunt; 49426 is for surgical revision of the shunt.
Should modifier 50 be reported for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the global period affect postoperative care?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be paid?
CMS applies a statutory restriction to assistant-at-surgery payment. Co-surgeons and team surgery are not permitted for this code.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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.
5,80349423,,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
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