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

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 Manhattan, NY, Medicare pays $909.51 for 49440 in the office and $200.81 when it’s performed in a hospital or facility.

$909.51Office (non-facility)
$200.81Hospital or facility
+15.4%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 Manhattan, NY
  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 Manhattan, NY 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. Manhattan, NY pays $909.51. The RVUs are the same everywhere; the geographic indexes change the dollars.

49440 in Manhattan, NY vs other payment areas
  1. Manhattan, NY · this page$909.51
  2. NYC suburbs and Long Island, NY · New York$930.85+$21.34
  3. Poughkeepsie and northern NYC suburbs, NY · New York$858.40−$51.11
  4. Queens, NY · New York$920.36+$10.85
  5. Rest of New York · New York$751.70−$157.81
  6. Los Angeles, CA · California$906.89−$2.62
  7. Washington, DC area · District of Columbia$911.78+$2.27

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

49440 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$836.71$201.80
Chicago, ILIllinois$810.99$198.04
AlaskaAlaska$887.76$238.22
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

49440 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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 Manhattan, NY 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

78

Locality
Manhattan, NY
Physician work
1.064
Practice expense
1.162
Malpractice
1.586
Office calculation for 49440 in Manhattan, NY
ComponentRVULocality factorAdjusted
Physician work3.83× 1.0644.0751
Practice expense19.34× 1.16222.4731
Malpractice0.43× 1.5860.6820
Total RVUs27.2302
Conversion factor× 33.4009

Office rate, Manhattan, NY$909.51

Office: (3.83 × 1.064 + 19.34 × 1.162 + 0.43 × 1.586) × $33.4009 = $909.51

Facility: (3.83 × 1.064 + 1.08 × 1.162 + 0.43 × 1.586) × $33.4009 = $200.81

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

Codes related to 49440

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 49440
CodeHow it relatesOffice range, Manhattan, NY
Same family
49441Enteral tube placement, duodenal or jejunal tubePercutaneous tube placement for duodenal or jejunal access rather than gastric access.$1,136.30
49442Cecostomy tube, percutaneous placementPercutaneous placement for cecostomy access rather than gastrostomy access.$854.74
Used instead
43246PEG placement, endoscopic guidanceEndoscopic gastrostomy placement; the access method differs from percutaneous image-guided placement.No office rate

How 49440 has changed in Manhattan, NY

49440 · Office / nonfacility

$909.51

Effective 2026-10-01

The base rate is $14.28 higher than on 2025-10-01, moving from $895.23 to $909.51 (1.6%).

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

    $895.23changed to$909.51

    • 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
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.166 changed to 1.162
    • Malpractice GPCI 1.656 changed to 1.586

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $943.62changed to$895.23

    • 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

    $928.22changed to$943.62

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1004.26changed to$928.22

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 20.87 changed to 20.14
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.184 changed to 1.166
    • Malpractice GPCI 1.843 changed to 1.656

  5. January 1, 2023

    RVU23A

    $1063.19changed to$1004.26

    • 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
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.203 changed to 1.184
    • Malpractice GPCI 2.031 changed to 1.843

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1132.29changed to$1063.19

    • 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

    $1135.30changed to$1132.29

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 22.35 changed to 22.90
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.192 changed to 1.203
    • Malpractice GPCI 1.823 changed to 2.031

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $1135.45changed to$1135.30

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 22.69 changed to 22.35
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.180 changed to 1.192
    • Malpractice GPCI 1.615 changed to 1.823

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $1154.87changed to$1135.45

    • 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

    $1149.15changed to$1154.87

    • 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
    • Practice expense GPCI 1.174 changed to 1.180
    • Malpractice GPCI 1.690 changed to 1.615

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1229.87changed to$1149.15

    • 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
    • Practice expense GPCI 1.168 changed to 1.174
    • Malpractice GPCI 1.764 changed to 1.690

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1234.54changed to$1229.87

    • 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

    $1228.39changed to$1234.54

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1227.88changed to$1228.39

    • 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
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.165 changed to 1.168
    • Malpractice GPCI 1.518 changed to 1.764

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $1255.83changed to$1227.88

    • 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
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.162 changed to 1.165
    • Malpractice GPCI 1.271 changed to 1.518

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $1255.83

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$909.51$200.81RVU26D
2026-07-01$909.51$200.81RVU26C
2026-04-01$909.51$200.81RVU26B
2026-01-01$909.51$200.81RVU26A
2025-10-01$895.23$220.49RVU25D
2025-07-01$895.23$220.49RVU25C
2025-04-01$895.23$220.49RVU25B
2025-01-01$895.23$220.49RVU25A
2024-10-01$943.62$223.64RVU24D
2024-07-01$943.62$223.64RVU24C
2024-04-01$943.62$223.64RVU24B
2024-03-09$943.62$223.64RVU24AR
2024-01-01$928.22$219.99RVU24A
2023-10-01$1,004.26$231.50RVU23D
2023-07-01$1,004.26$231.50RVU23C
2023-04-01$1,004.26$231.50RVU23B
2023-01-01$1,004.26$231.50RVU23A
2022-10-01$1,063.19$236.81RVU22D
2022-07-01$1,063.19$236.81RVU22C
2022-04-01$1,063.19$236.81RVU22B
2022-01-01$1,063.19$236.81RVU22A
2021-10-01$1,132.29$237.77RVU21D
2021-07-01$1,132.29$237.77RVU21C
2021-04-01$1,132.29$237.77RVU21B
2021-01-01$1,132.29$237.77RVU21A
2020-10-01$1,135.30$243.95RVU20D
2020-07-01$1,135.30$243.95RVU20C
2020-04-01$1,135.30$243.95RVU20B
2020-01-01$1,135.30$243.95RVU20A
2019-10-01$1,135.45$241.13RVU19D
2019-07-01$1,135.45$241.13RVU19C
2019-04-01$1,135.45$241.13RVU19B
2019-01-01$1,135.45$241.13RVU19A
2018-10-01$1,154.87$241.56RVU18D
2018-07-01$1,154.87$241.56RVU18C
2018-04-01$1,154.87$241.56RVU18B
2018-01-01$1,154.87$241.56RVU18AR1
2017-10-01$1,149.15$243.71RVU17D
2017-07-01$1,149.15$243.71RVU17C
2017-04-01$1,149.15$243.71RVU17B
2017-01-01$1,149.15$243.71RVU17A
2016-10-01$1,229.87$260.07RVU16D
2016-07-01$1,229.87$260.07RVU16C
2016-04-01$1,229.87$260.07RVU16B
2016-01-01$1,229.87$260.07RVU16A
2015-10-01$1,234.54$264.18RVU15D
2015-07-01$1,234.54$264.18RVU15C
2015-04-01$1,228.39$262.87RVU15B
2015-01-01$1,228.39$262.87RVU15A
2014-10-01$1,227.88$261.33RVU14D
2014-07-01$1,227.88$261.33RVU14C
2014-04-01$1,227.88$261.33RVU14B
2014-01-01$1,227.88$261.33RVU14A
2013-10-01$1,255.83$249.67RVU13D
2013-07-01$1,255.83$249.67RVU13C
2013-04-01$1,255.83$249.67RVU13B
2013-01-01$1,255.83$249.67RVU13AR

Price 49440 for an earlier date of service

Where the Manhattan, NY rate applies

Manhattan, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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 Manhattan, NYGPCI2026.csv, line 78 (RVU26D)

Open CMS sourceHow we calculate rates

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