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CPT 49425: Peritoneovenous Shunt Placement

CPT code 49425 identifies placement of a peritoneovenous shunt: a surgical procedure that connects the peritoneal cavity to the central venous system to divert ascitic fluid. Nationally, this code represents an infrequent but clinically significant intervention used for patients with refractory ascites when medical therapies are insufficient. It is relevant to hospitals, surgical specialties, and payers due to the procedure’s complexity, inpatient resource use, and potential complications.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the code, typical settings where the service is performed, and what to expect in billing and coverage discussions. The publication covers common modifiers and documentation considerations, national utilization and reimbursement benchmarks when available, and clinical context regarding indications and procedural implications. This summary is intended for billing professionals, clinicians involved in procedural care of ascites, and payer policy staff seeking a clear national perspective on CPT code 49425. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 49425 describes a surgical procedure that creates a controlled outlet for excess peritoneal fluid to drain into the venous circulation. In this operation, the surgeon inserts a catheter into the abdominal (peritoneal) cavity and connects it to a catheter placed in the internal jugular vein, establishing a pathway for ascitic fluid to be diverted away from the heart and into the venous system.

Service type: Surgical shunt placement for management of refractory ascites
Typical site of service: Hospital operating room or interventional suite where surgical venous and abdominal access can be performed under sterile conditions and imaging guidance when indicated

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CPT 49425: Peritoneovenous Shunt Placement

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Billing Code Overview

Service type: Surgical shunt placement for management of refractory ascites
Typical site of service: Hospital operating room or interventional suite where surgical venous and abdominal access can be performed under sterile conditions and imaging guidance when indicated

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with refractory ascites from cirrhosis (for example, decompensated alcoholic or viral hepatitis‑related cirrhosis) who has failed medical management including sodium restriction and diuretics and requires frequent large‑volume paracentesis. The patient presents with symptomatic tense ascites causing dyspnea, abdominal pain, poor appetite, or frequent hospital visits for therapeutic paracentesis. After multidisciplinary evaluation by hepatology and interventional radiology or vascular surgery, the decision is made to place a transjugular intrahepatic portosystemic shunt (TIPS) with a peritoneovenous shunt-like variant or to create a peritoneovenous drainage conduit by surgically connecting a peritoneal catheter to a central venous catheter via the jugular vein as described by CPT 49425.

The clinical workflow includes preoperative evaluation (laboratory tests, coagulation profile, imaging such as abdominal ultrasound or CT), informed consent, anesthesia evaluation (general or monitored anesthesia care), placement of an abdominal catheter into the peritoneal cavity and a central venous catheter in the internal jugular vein, tunneling and connection of catheters, verification of flow from peritoneum to central circulation, closure and postoperative monitoring for complications (infection, catheter dysfunction, bleeding, signs of heart overload). Postoperative follow‑up includes wound and catheter care, surveillance for disseminated intravascular coagulation or volume overload, and coordination with hepatology for ongoing ascites management.

Coding Specifications

Modifier	Description	When to Use
`00`	Default — no modifier reported	Rarely appended; use payer‑specific when required
`11`	New or additional procedure	Use when this is the initial primary service and payer requires explicit primary procedure indicator
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for `49425`
`23`	Unusual anesthesia — patient condition	Use when general anesthesia is required because of patient condition for `49425`
`52`	Reduced services	Use when the procedure is partially completed or aborted before completion
`53`	Discontinued procedure	Use when procedure is terminated due to extenuating circumstances after anesthesia is initiated
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the procedure
`66`	Surgical team approach	Use when multiple surgeons operate as a surgical team for complex cases
`76`	Repeat procedure by same physician	Data not available in the input.
`78`	Return to operating room for related procedure during global period	Use when an unplanned return to OR is required for a complication related to `49425`
`TC`	Technical component	Use when billing only the facility/technical component of the procedure

Taxonomy Code	Specialty	Notes
`207K00000X`	General Surgery	Surgeons may perform peritoneovenous shunt creation and catheter placement
`208000000X`	Vascular Surgery	Vascular surgeons manage central venous access and venous anastomoses
`208600000X`	Interventional Radiology	IR may perform image‑guided catheter placement and shunt creation
`207L00000X`	Transplant Hepatology	Hepatologists coordinate care and patient selection
`363L00000X`	Critical Care Medicine	Critical care physicians manage perioperative hemodynamic issues

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K70.30`	Alcoholic cirrhosis of liver without ascites	Less directly relevant — included when cirrhosis is underlying cause (use `K70.31` for with ascites)
`K70.31`	Alcoholic cirrhosis of liver with ascites	Common underlying diagnosis prompting peritoneovenous drainage via `49425`
`K74.60`	Unspecified cirrhosis of liver	Cirrhosis frequently leads to refractory ascites requiring this procedure
`R18.8`	Other ascites	Direct symptom/condition indicating therapeutic drainage or shunt creation
`R18.0`	Chylous ascites	Specific ascites etiology that may require specialized drainage approaches
`I50.9`	Heart failure, unspecified	Relevant as comorbidity — cardiac function must be considered before shunting peritoneal fluid into central circulation
`N39.0`	Urinary tract infection	Example of infection comorbidity — infections can affect perioperative management
`Z79.899`	Other long term (current) drug therapy	May be used to denote ongoing diuretic or medication therapy when documenting management

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Preoperative laboratory monitoring and routine blood draws prior to `49425`
`76937`	Ultrasound guidance for vascular access	May be used for ultrasound‑guided jugular vein catheter placement when performing `49425`
`36556`	Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older	Related central venous access technique; sometimes used when alternative central access is required during the procedure
`49652`	Laparoscopic lysis of adhesions, intraperitoneal	May be performed if intraabdominal adhesions must be lysed to place the peritoneal catheter during `49425`
`49422`	Peritoneal catheter placement (intraperitoneal)	Related procedure for insertion of peritoneal catheter; may be performed immediately before connecting to jugular catheter

CPT 49426: Repair or Replacement of Peritoneal Venous Shunt

CPT-49427-PERITONEAL-VENOUS-SHUNT-CONTRAST-INJECTION-EVALUATION

CPT 49427: Contrast Injection for Peritoneal Venous Shunt Evaluation

CPT-49428-PERITONEAL-VENOUS-SHUNT-LIGATION

CPT 49428: Ligation of Peritoneal-Venous Shunt

CPT-49429-PERITONEAL-VENOUS-CATHETER-REMOVAL

CPT 49429: Removal of Peritoneal Venous Catheter

CPT-49435-ABDOMINAL-CATHETER-EXTENSION-TUNNELED-UPPER-CHEST-EXIT

CPT 49435: Abdominal Catheter Extension Tunneled to Upper Chest Exit

CPT-49436-EXIT-SITE-CREATION-FOR-INTRAPERITONEAL-CATHETER

CPT 49436: Exit-Site Creation for Intraperitoneal Catheter

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	Default — no modifier reported	Rarely appended; use payer‑specific when required
`11`	New or additional procedure	Use when this is the initial primary service and payer requires explicit primary procedure indicator
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for `49425`
`23`	Unusual anesthesia — patient condition	Use when general anesthesia is required because of patient condition for `49425`
`52`	Reduced services	Use when the procedure is partially completed or aborted before completion
`53`	Discontinued procedure	Use when procedure is terminated due to extenuating circumstances after anesthesia is initiated
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the procedure
`66`	Surgical team approach	Use when multiple surgeons operate as a surgical team for complex cases
`76`	Repeat procedure by same physician	Data not available in the input.
`78`	Return to operating room for related procedure during global period	Use when an unplanned return to OR is required for a complication related to `49425`
`TC`	Technical component	Use when billing only the facility/technical component of the procedure

Taxonomy Code	Specialty	Notes
`207K00000X`	General Surgery	Surgeons may perform peritoneovenous shunt creation and catheter placement
`208000000X`	Vascular Surgery	Vascular surgeons manage central venous access and venous anastomoses
`208600000X`	Interventional Radiology	IR may perform image‑guided catheter placement and shunt creation
`207L00000X`	Transplant Hepatology	Hepatologists coordinate care and patient selection
`363L00000X`	Critical Care Medicine	Critical care physicians manage perioperative hemodynamic issues

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K70.30`	Alcoholic cirrhosis of liver without ascites	Less directly relevant — included when cirrhosis is underlying cause (use `K70.31` for with ascites)
`K70.31`	Alcoholic cirrhosis of liver with ascites	Common underlying diagnosis prompting peritoneovenous drainage via `49425`
`K74.60`	Unspecified cirrhosis of liver	Cirrhosis frequently leads to refractory ascites requiring this procedure
`R18.8`	Other ascites	Direct symptom/condition indicating therapeutic drainage or shunt creation
`R18.0`	Chylous ascites	Specific ascites etiology that may require specialized drainage approaches
`I50.9`	Heart failure, unspecified	Relevant as comorbidity — cardiac function must be considered before shunting peritoneal fluid into central circulation
`N39.0`	Urinary tract infection	Example of infection comorbidity — infections can affect perioperative management
`Z79.899`	Other long term (current) drug therapy	May be used to denote ongoing diuretic or medication therapy when documenting management

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Preoperative laboratory monitoring and routine blood draws prior to `49425`
`76937`	Ultrasound guidance for vascular access	May be used for ultrasound‑guided jugular vein catheter placement when performing `49425`
`36556`	Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older	Related central venous access technique; sometimes used when alternative central access is required during the procedure
`49652`	Laparoscopic lysis of adhesions, intraperitoneal	May be performed if intraabdominal adhesions must be lysed to place the peritoneal catheter during `49425`
`49422`	Peritoneal catheter placement (intraperitoneal)	Related procedure for insertion of peritoneal catheter; may be performed immediately before connecting to jugular catheter

CPT 49426: Repair or Replacement of Peritoneal Venous Shunt

CPT-49427-PERITONEAL-VENOUS-SHUNT-CONTRAST-INJECTION-EVALUATION

CPT 49427: Contrast Injection for Peritoneal Venous Shunt Evaluation

CPT-49428-PERITONEAL-VENOUS-SHUNT-LIGATION

CPT 49428: Ligation of Peritoneal-Venous Shunt

CPT-49429-PERITONEAL-VENOUS-CATHETER-REMOVAL

CPT 49429: Removal of Peritoneal Venous Catheter

CPT-49435-ABDOMINAL-CATHETER-EXTENSION-TUNNELED-UPPER-CHEST-EXIT

CPT 49435: Abdominal Catheter Extension Tunneled to Upper Chest Exit

CPT-49436-EXIT-SITE-CREATION-FOR-INTRAPERITONEAL-CATHETER

CPT 49436: Exit-Site Creation for Intraperitoneal Catheter

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

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CPT 49425: Peritoneovenous Shunt Placement

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Billing Code Overview

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CPT 49425: Peritoneovenous Shunt Placement

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References