Billing code 49185: Fluid collection treatmentMedicare rate & RVUs in Texas
Report percutaneous sclerotherapy when a clinician treats a defined fluid collection, such as a lymphocele, cyst, or seroma, by instilling a sclerosant.
Medicare pays $1,104.94–$1,270.41 for 49185 in the office in Texas, from Beaumont to Austin. 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 49185 covers
This service treats a defined fluid collection by percutaneously placing a needle or catheter and instilling a sclerosant to promote closure of the cavity. Typical targets include a lymphocele, cyst, or seroma. An interventional radiologist commonly performs the procedure in a hospital or outpatient setting, using imaging to access and treat the collection. The service includes contrast injection and radiological supervision and interpretation.
Report 49185 when the procedure is sclerotherapy of a fluid collection, rather than drainage alone, tissue sampling, or open removal. Documentation should identify the collection, describe percutaneous access and sclerosant treatment, and support the imaging and contrast work performed. The code has a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; 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 49185 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$1104.94 to $1270.41
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $1,270.41 | $105.31 |
| Beaumont | $1,104.94 | $102.82 |
| Brazoria | $1,194.77 | $103.45 |
| Dallas | $1,201.23 | $104.40 |
| Fort Worth | $1,190.16 | $104.35 |
| Galveston | $1,197.49 | $103.97 |
| Houston | $1,202.98 | $109.46 |
| Rest Of Texas | $1,148.35 | $103.29 |
How the 49185 rate is calculated
Each of 49185’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 · 49185
RVUs × geographic indexes × conversion factor
Work2.29
2.29 RVUs× 1.000 GPCI
Practice expense33.53
33.53 RVUs× 1.000 GPCI
Malpractice0.30
0.30 RVUs× 1.000 GPCI
Adjusted RVUs
36.1200
Conversion factor
$33.4009
Medicare rate
$1,206.44
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49185
The CMS indicators that decide how 49185 is paid alongside other services.
CMS payment indicators · 49185
Fluid collection treatment
| 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 | 0 | No multiple-procedure reduction. |
| 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. |
49185 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49405Visceral drainage
- Choose 49405 for image-guided percutaneous drainage of a visceral collection. Choose 49185 when the collection is treated with a sclerosant.
- 49406Catheter drainage
- Choose 49406 for image-guided percutaneous drainage of a peritoneal or retroperitoneal collection; 49185 describes sclerotherapy instead.
- 49180Mass biopsy
- 49180 is for biopsy of an abdominal mass to obtain tissue. It is not the code for sclerosing a fluid collection.
49185 billing questions
When should 49185 be selected instead of a fluid-collection drainage code?
Use 49185 when the clinician performs percutaneous sclerotherapy to treat the collection. Drainage codes describe catheter drainage, not sclerosant treatment.
Are imaging guidance and contrast reported separately?
The service includes contrast injection and radiological supervision and interpretation. Do not separately report those elements as separate services for the same sclerotherapy procedure.
Can modifier 50 be used for collections on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant, co-surgeon, or surgical team be paid?
Medicare does not pay an assistant at surgery for 49185. Co-surgeons and team surgery are not permitted.
What documentation supports reporting 49185?
Document the type and location of the collection, percutaneous access, sclerosant treatment, and imaging and contrast work. The record should make clear that the service was sclerotherapy rather than drainage alone.
What care is included in the global period?
The code has a 0-day global period. Same-day preoperative and postoperative care is included.
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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