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    OpenPayerBilling CodesPeritoneal-Venous Shunt ProceduresCPT cpt-49435-abdominal-catheter-extension-tunneled-upper-chest-exit
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    CPT 49435: Abdominal Catheter Extension Tunneled to Upper Chest Exit

    Medicare pays $106 on average nationally for this procedure.

    CPT code 49435 describes placement, during the same session as intraperitoneal cannula or catheter insertion, of an abdominal catheter extension that is tunneled subcutaneously to an upper chest exit site; the service is a surgical device placement procedure typically performed in an operating room or procedure suite as part of intraperitoneal access and catheter management.

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A patient with advanced malignancy or refractory ascites is scheduled for insertion of an intraperitoneal (IP) catheter for chronic intraperitoneal chemotherapy or long-term drainage. During the operative session the surgeon places the IP cannula or catheter into the peritoneal cavity and then constructs an abdominal catheter extension tunneled subcutaneously to an upper chest exit site to facilitate access, reduce infection risk at the abdominal wall, and allow secure external connection. Typical workflow: preoperative evaluation by surgical oncology or general surgery verifies indication (e.g., ovarian carcinoma requiring IP chemotherapy, malignant ascites), informed consent is obtained for catheter and subcutaneous tunneling, operating room setup with sterile field, induction of anesthesia (general or monitored anesthesia care), creation of laparoscopic or open peritoneal access, insertion of the intraperitoneal cannula/catheter, measurement and placement of extension tubing, creation of a subcutaneous tunnel from the abdomen to an upper chest pocket/exit, securement and dressing of the exit site, and documentation of catheter type, tunneling technique, laterality, and any intraoperative complications. Usual sites of service: ambulatory surgery center or hospital operating room. Typical providers: surgical oncologist, general surgeon, or gynecologic oncologist performing the procedure with nursing and anesthesia support.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49422Insertion of intraperitoneal catheter, open; with subcutaneous portOften performed as an alternative when a subcutaneous port is desired instead of an external tunneled extension
    49424Injection procedure for peritoneal cavity, percutaneous, catheter placementMay be used for image-guided percutaneous placement of IP access prior to or instead of open tunneling
    32820Thoracotomy; with insertion of indwelling pleural catheterNot directly the same cavity but similar tunneling and chest exit techniques; relevant when chest-site expertise is needed
    96360Intravenous infusion, hydration; initial, up to 1 hourMay be performed perioperatively for fluid management but not part of the surgical code itself
    71260CT chest without contrastPerformed if preoperative imaging of chest exit site or complications is required

    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…
    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…
    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…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208800000X
    363L00000X
    164W00000X
    163WC2100X
    2279S1500X
    222Q00000X
    101YA0400X
    224ZR0403X

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    C78.7Secondary malignant neoplasm of liver and intrahepatic bile duct
    E10.21Type 1 diabetes mellitus with diabetic nephropathy
    E11.22Type 2 diabetes mellitus with diabetic chronic kidney disease
    E86.0Dehydration
    E87.1Hypo-osmolality and hyponatremia
    I10Essential (primary) hypertension
    I50.9Heart failure, unspecified
    K57.20Diverticulitis of large intestine with perforation and abscess without bleeding
    K59.00Constipation, unspecified
    K65.9Peritonitis, unspecified

    Showing 1–10 of 25

    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-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-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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