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See a sample rate comparisonCPT 49426 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Shunt Placement In Abdomen, Procedure To Insert Shunt (Passage That Allows Movement Of Fluid From One Part Of The Body To Another).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None GC - Service performed by resident under supervision 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49426 |
| Medicaid Fee Schedule | View Medicaid rates for 49426 |
National average reimbursement for CPT 49426 by major payers:
$825.34
$871.90
$897.05
$1,055.57
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CPT 49426
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Cleburne
$11,871.00Published rateNorthridge Surgery Center, Lp, Northridge Surgery Center
Northridge Surgery Center Lp
$3,695.00Published rateThe Regents Of The University Of California, Ucla Dept Of Medicine
$2,703.00Published rateSurgery Center Jv, The Surgery Center Of Huntsville
The Surgery Center Of Huntsville
$1,563.00Published rateSwagel-Wootton Eye Center, Inc, Eye Surgery Center Of Arizona
Swagel/Wootton Eye Center, Ltd.
$504.00Published rate
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See a sample payer proposalCPT 49426 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49426 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 49426 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 49422-CPT | Moderate | Surgery To Remove Catheter, Surgery To Remove A Thin Tube (Catheter) That Had Been Surgically Embedded Under The Skin. |
| 49423-CPT | Moderate | Exchange Of Previously Placed, Exchange Of Previously Placed Abscess Or Cyst Drainagecatheter Under Radiological Guidance (Separateprocedure) |
| 49425-CPT | Moderate | Shunt Placement In Abdomen, Procedure To Insert Shunt (Passage That Allows Movement Of Fluid From One Part Of The Body To Another). |
| 49426-CPT | Moderate | Shunt Placement In Abdomen, Procedure To Insert Shunt (Passage That Allows Movement Of Fluid From One Part Of The Body To Another). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49426 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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