CPT code 49440: Gastrostomy placement, percutaneous, image-guided2026 Medicare rate & RVUs in Missouri
Reports image-guided percutaneous placement of a tube into the stomach for enteral feeding or gastric decompression, rather than endoscopic or surgical placement.
Medicare pays $698.74–$757.28 for 49440 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 49440 covers
A physician, commonly an interventional radiologist, creates percutaneous access to the stomach and places a gastrostomy tube under imaging guidance. The service is used when a patient needs enteral access for nutrition, hydration, or medication, or gastric decompression, and is commonly performed in a hospital or radiology setting. Fluoroscopic guidance, contrast injections, image documentation, and the report are part of the placement service.
Report this code for initial percutaneous placement into the stomach, not for a tube placed into the small bowel or for replacement of an existing tube. The procedure record should support the percutaneous route, gastric location, tube placement, and imaging used to confirm position. Related postoperative visits during the 10-day global period are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service; assistant-at-surgery payment requires documented medical necessity, and co-surgeon and team-surgery billing are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 49440 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$698.74 to $757.28
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $748.53 | $175.83 |
| Metropolitan St. Louis, MO | $757.28 | $176.66 |
| Rest of Missouri | $698.74 | $173.01 |
How the 49440 rate is calculated
Each of 49440’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 49440
RVUs × geographic indexes × conversion factor
Work3.83
3.83 RVUs× 1.000 GPCI
Practice expense19.34
19.34 RVUs× 1.000 GPCI
Malpractice0.43
0.43 RVUs× 1.000 GPCI
Adjusted RVUs
23.6000
Conversion factor
$33.4009
Medicare rate
$788.26
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49440
49440 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49440
Gastrostomy placement, percutaneous, image-guided
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49440
Gastrostomy placement, percutaneous, image-guided
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49440 without 51 · national office
$788.26
Gastrostomy placement, percutaneous, image-guided
49440-51 · Second procedure: 50%
$394.13
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
49440 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49441Enteral tube placementDuodenal or jejunal tube
- Use 49440 when the tube terminates in the stomach. Use 49441 for percutaneous access with the tube placed into the duodenum or jejunum.
- 49442Cecostomy tubePercutaneous placement
- 49442 is for percutaneous cecostomy tube placement; 49440 is for a tube placed into the stomach.
- 43246PEG placementEndoscopic guidance
- Choose 43246 for endoscopic gastrostomy placement. 49440 represents the percutaneous image-guided approach.
- 49450Feeding tube replacementGastrostomy or cecostomy
- 49450 is for percutaneous replacement of a gastrostomy or cecostomy tube, not initial gastrostomy tube placement.
49440 billing questions
How does 49440 differ from endoscopic gastrostomy placement?
49440 describes percutaneous placement using imaging guidance. Endoscopic placement, such as a PEG, uses an endoscope to establish and guide the access.
Is fluoroscopic guidance separately reported?
No. Fluoroscopic guidance, contrast injections, image documentation, and the report are included in the placement service.
Can modifier 50 be used for two-sided placement?
No. Modifier 50 is inappropriate for this gastrostomy placement service.
Does 49440 cover follow-up visits after placement?
Related postoperative visits during the 10-day global period are included.
When is assistant-at-surgery payment allowed?
Only when medical necessity for the assistant is documented. Co-surgeon and team-surgery billing are not permitted.
How is 49440 affected when other procedures occur in the same session?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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