49083
Paracentesis with imaging guidance
Paracentesis (abdominal) with imaging guidance, including ultrasound or fluoroscopy. CMS 2026 global wRVU 1.66, total RVU approximately 2.99, Medicare global allowable approximately $100. The bundled code for image-guided paracentesis; replaces separately billing 49082 (no imaging) plus 76942 (US guidance).
When to use it
Use 49083 when paracentesis is performed with real-time imaging guidance (ultrasound is most common; fluoroscopy in rare cases). Standard indications: diagnostic paracentesis in new-onset ascites, large-volume therapeutic paracentesis for tense ascites, refractory ascites in cirrhosis, suspected spontaneous bacterial peritonitis (SBP), oncology-related malignant ascites.
Full guidance
49082 (without imaging) is rarely the right code now that bedside ultrasound is widely available; use 49082 only when imaging was truly not used.
Documentation checklist
- ✓Procedure note covering: indication, consent, sterile technique, US (or fluoro) guidance with target site identified, anesthesia, needle / catheter type, fluid removed (volume, appearance), post-procedure assessment (BP, pain), complications.
- ✓Image saved showing fluid pocket and needle trajectory.
- ✓If large-volume therapeutic (typically more than 5 L), albumin replacement protocol documented.
- ✓Fluid sent to lab with appropriate studies (cell count and differential, albumin, total protein, culture, cytology when indicated).
- ✓Setting modifier; signed report.
Common pitfalls
- !Billing 49083 plus 76942 (US guidance for needle) separately on the same date for the same patient. NEVER do this; 76942 is bundled into 49083.
- !Billing 49082 (no imaging) and then also billing 76942. If imaging was used, the correct code is 49083 (the bundled code).
- !Missing the fluid analysis orders. Diagnostic paracentesis requires cell count / differential, albumin, culture; without these the clinical purpose of the diagnostic tap is incomplete.
- !Stacking 49083 multiple times within a hospital stay without indication for each tap. Each procedure is separately billable when clinically indicated and documented.
- !Confusing 49083 (paracentesis) with 32555 (thoracentesis with imaging) — different anatomic regions.
Payer notes
Medicare and commercial payers cover 49083 routinely for appropriate indications. Inpatient hospital codes follow DRG bundling. Outpatient IR procedures may require prior authorization for elective large-volume taps in stable patients. Document the indication, fluid analysis ordered, and post-procedure status.