Billing code 49426: Shunt revisionMedicare rate & RVUs in Ohio
Report revision of an existing peritoneovenous shunt when surgery is performed to correct a problem with the shunt used to manage ascites.
CMS doesn’t publish an office rate for 49426 in Ohio.
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 49426 covers
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.
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 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $624.82 |
How the 49426 rate is calculated
Each of 49426’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 · 49426
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.15Practice expense 6.38Malpractice 2.71
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49426
49426 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49426
Shunt revision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49426
Shunt revision
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49426 without 51 · national facility
$642.63
Shunt revision
49426-51 · Second procedure: 50%
$321.32
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
49426 compared with similar codes
Compare codes
49426 vs 49425 vs 49427 vs 49428 vs 49429: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49425Abdominal shunt
- 49425 is for initial peritoneovenous shunt placement. Choose 49426 when the surgeon revises a shunt that is already present.
- 49427Shunt injection
- 49427 covers injection to evaluate a peritoneovenous shunt; it is not the surgical revision service reported with 49426.
- 49428Shunt ligation
- 49428 is for ligating the shunt. Report 49426 when the procedure revises the shunt rather than ligating it.
- 49429Shunt removal
- 49429 is for removing the shunt. Use 49426 when the shunt is revised and remains in place.
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 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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