CPT code 49440: Gastrostomy placement, percutaneous, image-guided2026 Medicare rate & RVUs in North Dakota

Reports image-guided percutaneous placement of a tube into the stomach for enteral feeding or gastric decompression, rather than endoscopic or surgical placement.

CMS RVU26DEffective Oct 1, 2026One payment locality18.4K Medicare services in 2024

In North Dakota, Medicare pays $779.73 for 49440 in the office and $169.83 when it’s performed in a hospital or facility.

$779.73Office (non-facility)
$169.83Hospital or facility
−1.1%vs the national office rate ($788.26)

Check a contract rate as a % of Medicare · 49440 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 49440 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Dakota
  2. What 49440 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How North Dakota compares for 49440

Across 109 of 109 payment localities, the office rate for 49440 runs from $690.21 in Arkansas to $1,081.19 in San Benito County, CA. North Dakota pays $779.73. The RVUs are the same everywhere; the geographic indexes change the dollars.

49440 in North Dakota vs other payment areas
  1. North Dakota · this page$779.73
  2. Los Angeles, CA · California$906.89+$127.16
  3. Washington, DC area · District of Columbia$911.78+$132.05
  4. Miami, FL · Florida$836.71+$56.98
  5. Chicago, IL · Illinois$810.99+$31.26
  6. Manhattan, NY · New York$909.51+$129.78
  7. Alaska · Alaska$887.76+$108.03

Other areas in North Dakota first, then benchmark localities. Bars start at $0.

Every other payment area

49440 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$701.28$167.62
ArkansasArkansas$690.21$166.31
ArizonaArizona$766.17$175.17
Bakersfield, CACalifornia$847.09$178.64
Chico, CACalifornia$845.79$177.33
El Centro, CACalifornia$845.86$177.41
Fresno, CACalifornia$845.79$177.33
Hanford, CACalifornia$845.79$177.33

49440 rates by state

Office rate range in each state. Select a state to see its payment localities.

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$690.21

$963.49

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
49440 office rate range by state
State / territoryOffice rate rangeLocalities
AK$887.761
AL$701.281
AR$690.211
AZ$766.171
CA$845.79–$1,081.1929
CO$827.991
CT$843.581
DC$911.781
DE$779.701
FL$767.06–$836.713
GA$721.25–$801.872
GU$870.711
HI$870.711
IA$724.691
ID$729.011
IL$740.15–$817.694
IN$733.721
KS$719.121
KY$715.341
LA$713.37–$752.102
MA$821.63–$917.252
MD$796.11–$911.783
ME$731.15–$777.152
MI$733.91–$775.502
MN$796.881
MO$698.74–$757.283
MS$694.721
MT$788.231
NC$739.801
ND$779.731
NE$729.591
NH$812.951
NJ$854.20–$900.652
NM$737.531
NV$786.511
NY$751.70–$930.855
OH$732.181
OK$715.941
OR$781.41–$858.332
PA$734.50–$819.822
PR$795.151
RI$810.461
SC$737.011
SD$778.721
TN$722.831
TX$729.10–$824.358
UT$748.041
VA$773.06–$911.782
VI$795.151
VT$774.711
WA$820.73–$938.672
WI$751.191
WV$709.831
WY$784.531

See 49440 in every payment locality

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

Office or facility?

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.

The exact North Dakota inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,812

Code
49440
Physician work
3.83
Practice expense
19.34
Malpractice
0.43

GPCI2026.csv

84

Locality
North Dakota
Physician work
1.000
Practice expense
1.000
Malpractice
0.406
Office calculation for 49440 in North Dakota
ComponentRVULocality factorAdjusted
Physician work3.83× 1.0003.8300
Practice expense19.34× 1.00019.3400
Malpractice0.43× 0.4060.1746
Total RVUs23.3446
Conversion factor× 33.4009

Office rate, North Dakota$779.73

Office: (3.83 × 1 + 19.34 × 1 + 0.43 × 0.406) × $33.4009 = $779.73

Facility: (3.83 × 1 + 1.08 × 1 + 0.43 × 0.406) × $33.4009 = $169.83

Open 49440 in the RVU calculator

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

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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%).

When to use modifier 51

How 49440 has changed in North Dakota

49440 · Office / nonfacility

$779.73

Effective 2026-10-01

The base rate is $13.21 higher than on 2025-10-01, moving from $766.52 to $779.73 (1.7%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
  1. January 1, 2026

    RVU26A

    $766.52changed to$779.73

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.93 changed to 3.83
    • Practice expense RVU 19.55 changed to 19.34
    • Malpractice RVU 0.42 changed to 0.43
    • Malpractice GPCI 0.517 changed to 0.406

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $808.29changed to$766.52

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 20.14 changed to 19.55
    • Malpractice RVU 0.41 changed to 0.42

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $795.09changed to$808.29

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $846.99changed to$795.09

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 20.87 changed to 20.14
    • Malpractice GPCI 0.474 changed to 0.517
  5. January 1, 2023

    RVU23A

    $883.43changed to$846.99

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 21.43 changed to 20.87
    • Malpractice RVU 0.39 changed to 0.41
    • Malpractice GPCI 0.431 changed to 0.474

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $941.75changed to$883.43

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 22.90 changed to 21.43
    • Malpractice RVU 0.37 changed to 0.39

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $954.91changed to$941.75

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 22.35 changed to 22.90
    • Malpractice GPCI 0.485 changed to 0.431

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $966.56changed to$954.91

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 22.69 changed to 22.35
    • Malpractice GPCI 0.540 changed to 0.485

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $983.31changed to$966.56

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 23.19 changed to 22.69
    • Malpractice RVU 0.36 changed to 0.37

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $981.64changed to$983.31

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 23.22 changed to 23.19
    • Malpractice RVU 0.37 changed to 0.36
    • Malpractice GPCI 0.547 changed to 0.540

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1054.14changed to$981.64

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 4.18 changed to 3.93
    • Practice expense RVU 25.04 changed to 23.22
    • Malpractice RVU 0.40 changed to 0.37
    • Malpractice GPCI 0.554 changed to 0.547

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1056.42changed to$1054.14

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 24.97 changed to 25.04
    • Malpractice RVU 0.45 changed to 0.40

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $1051.16changed to$1056.42

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1055.22changed to$1051.16

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 25.03 changed to 24.97
    • Malpractice RVU 0.46 changed to 0.45
    • Malpractice GPCI 0.536 changed to 0.554

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $1083.57changed to$1055.22

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 27.42 changed to 25.03
    • Malpractice RVU 0.48 changed to 0.46
    • Malpractice GPCI 0.517 changed to 0.536

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $1083.57

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$779.73$169.83RVU26D
2026-07-01$779.73$169.83RVU26C
2026-04-01$779.73$169.83RVU26B
2026-01-01$779.73$169.83RVU26A
2025-10-01$766.52$187.84RVU25D
2025-07-01$766.52$187.84RVU25C
2025-04-01$766.52$187.84RVU25B
2025-01-01$766.52$187.84RVU25A
2024-10-01$808.29$190.80RVU24D
2024-07-01$808.29$190.80RVU24C
2024-04-01$808.29$190.80RVU24B
2024-03-09$808.29$190.80RVU24AR
2024-01-01$795.09$187.69RVU24A
2023-10-01$846.99$194.32RVU23D
2023-07-01$846.99$194.32RVU23C
2023-04-01$846.99$194.32RVU23B
2023-01-01$846.99$194.32RVU23A
2022-10-01$883.43$196.50RVU22D
2022-07-01$883.43$196.50RVU22C
2022-04-01$883.43$196.50RVU22B
2022-01-01$883.43$196.50RVU22A
2021-10-01$941.75$198.17RVU21D
2021-07-01$941.75$198.17RVU21C
2021-04-01$941.75$198.17RVU21B
2021-01-01$941.75$198.17RVU21A
2020-10-01$954.91$207.13RVU20D
2020-07-01$954.91$207.13RVU20C
2020-04-01$954.91$207.13RVU20B
2020-01-01$954.91$207.13RVU20A
2019-10-01$966.56$208.66RVU19D
2019-07-01$966.56$208.66RVU19C
2019-04-01$966.56$208.66RVU19B
2019-01-01$966.56$208.66RVU19A
2018-10-01$983.31$209.32RVU18D
2018-07-01$983.31$209.32RVU18C
2018-04-01$983.31$209.32RVU18B
2018-01-01$983.31$209.32RVU18AR1
2017-10-01$981.64$210.39RVU17D
2017-07-01$981.64$210.39RVU17C
2017-04-01$981.64$210.39RVU17B
2017-01-01$981.64$210.39RVU17A
2016-10-01$1,054.14$223.83RVU16D
2016-07-01$1,054.14$223.83RVU16C
2016-04-01$1,054.14$223.83RVU16B
2016-01-01$1,054.14$223.83RVU16A
2015-10-01$1,056.42$225.64RVU15D
2015-07-01$1,056.42$225.64RVU15C
2015-04-01$1,051.16$224.51RVU15B
2015-01-01$1,051.16$224.51RVU15A
2014-10-01$1,055.22$225.56RVU14D
2014-07-01$1,055.22$225.56RVU14C
2014-04-01$1,055.22$225.56RVU14B
2014-01-01$1,055.22$225.56RVU14A
2013-10-01$1,083.57$217.68RVU13D
2013-07-01$1,083.57$217.68RVU13C
2013-04-01$1,083.57$217.68RVU13B
2013-01-01$1,083.57$217.68RVU13AR

Price 49440 for an earlier date of service

Where the North Dakota rate applies

North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.

  • Abercrombie
  • Adams
  • Alamo
  • Alexander
  • Alice
  • Almont
  • Alsen
  • Ambrose

Browse all communities in North Dakota

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
RVUs for 49440PPRRVU2026_Oct_nonQPP.csv, line 5,812 (RVU26D)
Geographic factors for North DakotaGPCI2026.csv, line 84 (RVU26D)

Open CMS sourceHow we calculate rates

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