CPT 49406 Peritoneal/Retroperitoneal Drainage Reimbursement | OpenPayer

Summary & Overview

CPT 49406: Image-Guided Peritoneal or Retroperitoneal Catheter Drainage

CPT code 49406 represents an image-guided catheter drainage procedure targeting the peritoneal or retroperitoneal space. It covers placement of a catheter through a small skin incision under imaging guidance with subsequent drainage of the targeted collection. This procedure is commonly performed by interventional radiology teams and matters nationally because it is a key minimally invasive option for managing intra-abdominal and retroperitoneal fluid collections, impacting hospital length of stay, infection control, and resource utilization.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the operational implications for facilities and imaging services. The publication summarizes common billing considerations, payer coverage patterns, and procedural benchmarks where available.

The report provides practical reference material: a clinical description of the procedure, how it is coded and billed, and what operational stakeholders should expect in terms of site of service and provider roles. Data not available in the input for this code are clearly noted elsewhere in the publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 49406image-guided drainageinterventional radiologyperitoneal drainageretroperitoneal drainageprocedural codingradiologic procedureshospital services

Billing Code Overview

CPT code 49406 describes a procedure in which a provider uses imaging guidance to direct a catheter through a small incision in the skin to a peritoneal or retroperitoneal area and then drains the targeted area once the catheter is positioned. This procedure is an image-guided catheter drainage of the peritoneal or retroperitoneal space.

Service type: Image-guided catheter drainage procedure
Typical site of service: Interventional radiology suite, inpatient procedure room, or ambulatory surgery center, depending on clinical need and patient status.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting with symptomatic ascites or a localized fluid collection in the peritoneal or retroperitoneal space (for example, refractory malignant ascites, cirrhosis-related ascites, or a peritoneal abscess requiring drainage). The patient undergoes pre-procedure evaluation including history, focused physical exam, coagulation assessment, and informed consent. Imaging (usually ultrasound or CT) is reviewed to confirm fluid location and safe percutaneous access path. In the interventional suite or radiology procedure room, conscious sedation or monitored anesthesia care is provided as appropriate. Under sterile conditions, the interventional radiologist or other qualified proceduralist uses real-time imaging guidance to place a trocar or peel-away sheath through a small skin incision and advance a catheter into the targeted peritoneal or retroperitoneal collection. Once catheter position is confirmed, fluid is aspirated or drained; samples may be sent for laboratory analysis. Post-procedure, the catheter may be left in place for ongoing drainage or removed based on clinical judgment. Typical site of service is the hospital outpatient department, radiology suite, or inpatient interventional radiology unit. Billing uses 49406 for the image-guided percutaneous catheter drainage of a peritoneal or retroperitoneal area.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component

CPT 49405: Image-Guided Percutaneous Catheter Drainage, Abdomen and Chest

CPT-49407-IMAGE-GUIDED-TRANSVAGINAL-TRANSRECTAL-CATHETER-DRAINAGE

CPT 49407: Image-Guided Transvaginal or Transrectal Catheter Drainage

Taxonomy Code	Specialty	Notes
207P00000X	Interventional Radiology	Most common specialty performing image-guided percutaneous peritoneal/retroperitoneal drainage
363L00000X	Diagnostic Radiology	Diagnostic radiologists with procedural privileges frequently perform this service
2080P0206X	General Surgery	Surgeons with percutaneous drainage experience may perform in operative or interventional settings
207MR0200X	Vascular & Interventional Radiology	Equivalent interventional subspecialty taxonomy for percutaneous drainage procedures
207L00000X	Emergency Medicine	Emergency physicians with bedside ultrasound and procedural skills may perform emergent drainage

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K65.9`	Peritonitis, unspecified	Peritoneal infection with loculated fluid collections requiring drainage
`R18.8`	Other ascites	Ascites causing symptoms or refractory to medical therapy prompting therapeutic paracentesis or catheter drainage
`K65.0`	Acute peritonitis	Acute intra-abdominal infection leading to fluid collection and need for drainage
`K68.2`	Peritoneal abscess	Localized abscess in the peritoneal cavity often requiring percutaneous drainage
`K65.1`	Pilonidal cyst with abscess (if peritoneal/retroperitoneal extension)	When collections extend and require percutaneous drainage — included when clinically applicable
`C78.7`	Secondary malignant neoplasm of liver and intra-abdominal lymph nodes	Malignant ascites from intra-abdominal malignancy may require palliative drainage
`K74.60`	Unspecified cirrhosis of liver	Cirrhosis-associated portal hypertension leading to recurrent ascites requiring drainage

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`76942`	Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation	Often billed when real-time ultrasound guidance is used to place the catheter for `49406`
`77012`	Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation	Billed when CT guidance is used for needle/catheter placement during `49406`
`49083`	Drainage of peritoneal abscess, percutaneous, with catheter placement	Alternative or related percutaneous drainage codes for localized peritoneal abscess depending on clinical documentation and payer rules
`36010`	Introduction of needle or catheter into central venous catheter; initial placement	May be performed before or after `49406` if central venous access is required for fluid management or medication delivery
`71045`	Chest x-ray, single view, portable	Often performed post-procedure to verify catheter position or assess for immediate complications if thoracoabdominal involvement is suspected
`99223`	Initial hospital care, typically 70 minutes or more	Example E/M code for inpatient evaluation when `49406` is performed on an inpatient and a comprehensive admission history and exam are documented

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