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    v1.0.30
    OpenPayerBilling CodesPeritoneal-Venous Shunt ProceduresCPT cpt-49428-peritoneal-venous-shunt-ligation
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    CPT 49428: Ligation of Peritoneal-Venous Shunt

    Medicare pays $415 on average nationally for this procedure.

    CPT code 49428 describes surgical ligation of an existing peritoneal-venous shunt (tying off the tube connecting an abdominal catheter to a neck vein catheter) to stop flow through the shunt; this is a minor surgical procedure performed in an operating room or procedure suite and is classified as a surgical service addressing shunt malfunction, infection control, or removal of nonfunctioning hardware.

    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 58-year-old patient with a previously placed peritoneovenous (Denver) shunt for refractory ascites presents with signs of shunt-related complications, including recurrent infection at the catheter exit site and persistent ascites despite functioning drainage pathway. After multidisciplinary review, the surgical team schedules a brief operating room procedure to ligate the existing peritoneovenous shunt to stop flow through the device and eliminate the source of contamination. Preoperative evaluation includes review of prior imaging and operative reports, targeted labs, and informed consent documenting indication and risks. The patient receives local or general anesthesia per anesthesiology and surgeon preference. Intraoperatively the surgeon identifies the shunt tubing tract between the peritoneal cavity and the central venous catheter, isolates the externalized tubing, and ligates or clips the shunt to interrupt flow. Hemostasis is confirmed and the wound is closed. Postoperative workflow includes recovery monitoring, wound care instructions, infection surveillance, and documentation of device removal/ligation in the operative note and the medical record for billing and durable medical equipment reconciliation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49440Removal of peritoneal catheterPeritoneal catheter removal may be performed concomitantly or as a subsequent procedure after ligation to prevent recurrence
    36556Insertion of tunneled centrally inserted central venous catheter, without subcutaneous portIf a venous catheter component requires replacement or revision after shunt ligation
    49999Unlisted procedure, abdomenUsed when a specific unlisted abdominal procedure related to complex shunt work is performed and no specific code applies
    49320Diagnostic laparoscopyMay precede shunt ligation to evaluate intraperitoneal adhesions or catheter position
    11042Debridement, subcutaneous tissueIf wound infection or cellulitis around the catheter exit site requires debridement during the same operative session

    Related Modifiers

    9 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…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    207L00000X
    2471V0105X
    2251E1200X
    261QX0203X
    202C00000X
    246RP1900X
    173C00000X

    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-49425-PERITONEOVENOUS-SHUNT-PLACEMENT

    CPT 49425: Peritoneovenous Shunt Placement for Ascites

    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-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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