Billing code 49428: Shunt ligationMedicare rate & RVUs in Washington
Ligation of a peritoneovenous shunt permanently closes the channel carrying ascitic fluid into venous circulation when the shunt is taken out of service.
CMS doesn’t publish an office rate for 49428 in Washington.
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 49428 covers
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.
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 49428 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $407.00 |
| Seattle (King Cnty) | Unavailable | $440.92 |
How the 49428 rate is calculated
Each of 49428’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 · 49428
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.70Practice expense 3.84Malpractice 1.78
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49428
49428 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49428
Shunt ligation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49428
Shunt ligation
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49428 without 51 · national facility
$411.50
Shunt ligation
49428-51 · Second procedure: 50%
$205.75
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%).
49428 compared with similar codes
Compare codes
49428 vs 49426 vs 49427 vs 49429 vs 49425: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49426Shunt revision
- Choose 49426 when the shunt is revised and remains in use. Choose 49428 when the operation closes the shunt to stop flow.
- 49427Shunt injection
- 49427 describes injection of an abdominal venous shunt, not its surgical closure.
- 49429Shunt removal
- 49429 is for removing the shunt; 49428 closes it by ligation while leaving it in place.
- 49425Abdominal shunt
- 49425 is for placing an abdominal venous shunt, whereas 49428 closes an existing peritoneovenous shunt.
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 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
Fee sheets
Put 49428 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →