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    v1.0.30
    OpenPayerBilling CodesPeritoneal-Venous Shunt ProceduresCPT cpt-49425-peritoneovenous-shunt-placement
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    CPT 49425: Peritoneovenous Shunt Placement for Ascites

    Medicare pays $754 on average nationally for this procedure.

    CPT code 49425 describes surgical creation of a peritoneovenous shunt by inserting a catheter into the abdominal cavity and connecting it to a catheter placed in the jugular vein to drain ascitic fluid into the venous system; this is an operative drainage and shunt placement procedure typically performed by surgeons or interventional specialists as an operating room or interventional suite service for management of refractory ascites and related fluid accumulation.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    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.

    Related CPT Codes

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

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    208000000X
    208600000X
    207L00000X
    363L00000X
    2085R0204X
    324500000X
    207SM0001X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    B18.2Chronic viral hepatitis C
    B18.9Chronic viral hepatitis, unspecified
    C22.0Liver cell carcinoma
    C78.4Secondary malignant neoplasm of small intestine
    C78.5Secondary malignant neoplasm of large intestine and rectum
    C78.6Secondary malignant neoplasm of retroperitoneum and peritoneum
    C78.7Secondary malignant neoplasm of liver and intrahepatic bile duct
    C79.9Secondary malignant neoplasm of unspecified site
    I82.90Acute embolism and thrombosis of unspecified vein
    I85.00Esophageal varices without bleeding

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

    CPT-49426-PERITONEAL-VENOUS-SHUNT-REPAIR-REPLACEMENT

    CPT 49426: Repair or Replacement of Peritoneal-Venous Shunt

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

    CPT 49427: Peritoneal Venous Shunt Contrast Injection

    CPT-49428-PERITONEAL-VENOUS-SHUNT-LIGATION

    CPT 49428: Ligation of Peritoneal-Venous Shunt

    CPT-49429-PERITONEAL-VENOUS-CATHETER-REMOVAL

    CPT 49429: Peritoneal Venous Catheter Removal

    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

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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