CPT code 49442: Cecostomy tube, percutaneous placement2026 Medicare rate & RVUs
Report percutaneous cecostomy tube placement when a clinician establishes image-guided access to the cecum, often for antegrade bowel irrigation.
Medicare pays $741.50 for 49442 nationally in the office and $178.36 in a hospital or facility. Local office rates run $650.05–$1,017.76.
Medicare rate · 49442
Cecostomy tube, percutaneous placement
- Work RVUs
- 3.66
- Total RVUs
- 22.20
- Global days
- 010
National rate · 2026
$741.50
Office setting, before claim adjustments.
See every locality for 49442 →Billed by an NP, PA or therapist? →
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 10 sections
What 49442 covers
A clinician advances a tube through the abdominal wall into the cecum using percutaneous, fluoroscopic guidance. Interventional radiologists commonly perform this procedure in a facility setting. A cecostomy can provide access for antegrade colonic irrigation in patients with severe refractory constipation or neurogenic bowel. The service is distinct from access to the stomach, duodenum, or jejunum.
Report this code for placement of a new cecostomy tube, not routine exchange of an existing tube. Document the cecal target, percutaneous approach, tube placement, and imaging guidance. 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 receive the standard multiple-procedure reduction. Report one unit for the cecal access; modifier 50 is inappropriate. An assistant is paid only when medical necessity is documented; co-surgeon and team-surgery reporting 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 49442 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$650.05 to $1017.76
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $660.38 | $167.63 |
| Alaska | $836.69 | $236.95 |
| Arizona | $720.94 | $175.26 |
| Arkansas | $650.05 | $166.31 |
| Atlanta, GA | $754.00 | $181.85 |
| Austin, TX | $775.59 | $179.79 |
| Bakersfield, CA | $797.42 | $180.21 |
| Baltimore area, MD | $790.63 | $186.39 |
| Beaumont, TX | $686.00 | $173.54 |
| Brazoria, TX | $734.37 | $176.30 |
| Chicago, IL | $760.96 | $195.01 |
| Chico, CA | $796.29 | $179.09 |
| Colorado | $779.20 | $180.02 |
| Connecticut | $793.23 | $186.73 |
| Dallas, TX | $738.46 | $177.58 |
| Delaware | $733.61 | $177.23 |
| Detroit, MI | $728.50 | $185.07 |
| East St. Louis, IL | $705.11 | $187.03 |
| El Centro, CA | $796.35 | $179.15 |
| Fort Lauderdale, FL | $759.11 | $188.65 |
| Fort Worth, TX | $732.55 | $177.29 |
| Fresno, CA | $796.29 | $179.09 |
| Galveston, TX | $736.16 | $176.96 |
| Hanford, CA | $796.29 | $179.09 |
| Hawaii, Guam, HI | $819.63 | $179.34 |
| Houston, TX | $742.75 | $183.55 |
| Idaho | $686.58 | $168.50 |
| Indiana | $690.99 | $168.96 |
| Iowa | $682.63 | $167.36 |
| Kansas | $677.24 | $168.16 |
| Kentucky | $673.08 | $172.44 |
| King County, WA | $883.25 | $192.28 |
| Los Angeles, CA | $853.59 | $187.40 |
| Madera, CA | $796.29 | $179.09 |
| Manhattan, NY | $854.74 | $200.37 |
| Marin County, CA | $995.57 | $201.55 |
| Merced, CA | $796.29 | $179.09 |
| Metropolitan Boston, MA | $862.99 | $190.60 |
| Metropolitan Kansas City, MO | $704.18 | $175.39 |
| Metropolitan Philadelphia, PA | $770.92 | $184.69 |
| Metropolitan St. Louis, MO | $712.38 | $176.27 |
| Miami, FL | $784.78 | $198.55 |
| Minnesota | $750.64 | $171.17 |
| Mississippi | $653.96 | $169.09 |
| Modesto, CA | $796.29 | $179.09 |
| Montana | $741.48 | $178.34 |
| Napa, CA | $936.38 | $194.17 |
| Nebraska | $687.26 | $167.49 |
| Nevada | $740.10 | $176.40 |
| New Hampshire | $764.89 | $178.67 |
| New Mexico | $693.52 | $177.12 |
| New Orleans, LA | $707.31 | $177.39 |
| North Carolina | $696.47 | $171.07 |
| North Dakota | $734.36 | $171.22 |
| Northern New Jersey | $847.18 | $193.93 |
| NYC suburbs and Long Island, NY | $874.39 | $204.82 |
| Ohio | $688.77 | $174.62 |
| Oklahoma | $673.85 | $170.96 |
| Oxnard, CA | $850.91 | $185.27 |
| Portland, OR | $807.78 | $182.13 |
| Poughkeepsie and northern NYC suburbs, NY | $807.21 | $190.58 |
| Puerto Rico | $748.00 | $178.67 |
| Queens, NY | $865.15 | $199.52 |
| Redding, CA | $796.29 | $179.09 |
| Rest of California | $796.29 | $179.09 |
| Rest of Florida | $720.83 | $182.47 |
| Rest of Georgia | $678.23 | $175.91 |
| Rest of Illinois | $695.44 | $181.29 |
| Rest of Louisiana | $671.16 | $172.79 |
| Rest of Maine | $688.38 | $170.29 |
| Rest of Maryland | $749.02 | $179.13 |
| Rest of Massachusetts | $773.20 | $180.21 |
| Rest of Michigan | $690.22 | $176.08 |
| Rest of Missouri | $657.39 | $171.96 |
| Rest of New Jersey | $803.42 | $188.47 |
| Rest of New York | $707.57 | $172.59 |
| Rest of Oregon | $735.50 | $174.61 |
| Rest of Pennsylvania | $691.05 | $174.08 |
| Rest of Texas | $709.36 | $174.95 |
| Rest of Washington | $772.40 | $179.41 |
| Rhode Island | $762.56 | $180.84 |
| Riverside, CA | $800.23 | $183.03 |
| Sacramento, CA | $839.30 | $184.37 |
| Salinas, CA | $836.26 | $183.58 |
| San Benito County, CA | $1,017.76 | $205.72 |
| San Diego, CA | $858.68 | $185.16 |
| San Francisco, CA | $995.16 | $201.14 |
| San Luis Obispo, CA | $822.40 | $180.99 |
| Santa Clara County, CA | $1,016.09 | $204.04 |
| Santa Cruz, CA | $869.04 | $184.83 |
| Santa Maria, CA | $840.14 | $183.52 |
| Santa Rosa, CA | $878.04 | $186.50 |
| South Carolina | $693.55 | $173.21 |
| South Dakota | $733.52 | $170.38 |
| Southern Maine, ME | $731.60 | $173.53 |
| Stockton, CA | $796.29 | $179.09 |
| Suburban Chicago, IL | $768.03 | $189.69 |
| Tennessee | $680.67 | $168.78 |
| Utah | $703.84 | $174.49 |
| Vallejo, CA | $935.80 | $193.58 |
| Vermont | $729.49 | $171.98 |
| Virgin Islands, VI | $748.00 | $178.67 |
| Virginia | $727.64 | $174.08 |
| Visalia, CA | $796.29 | $179.09 |
| Washington, DC area | $857.55 | $194.17 |
| West Virginia | $667.14 | $177.77 |
| Wisconsin | $707.68 | $168.19 |
| Wyoming | $738.37 | $175.23 |
| Yuba City, CA | $796.29 | $179.09 |
49442 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.
$650.05
$907.03
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $836.69 | 1 |
| AL | $660.38 | 1 |
| AR | $650.05 | 1 |
| AZ | $720.94 | 1 |
| CA | $796.29–$1,017.76 | 29 |
| CO | $779.20 | 1 |
| CT | $793.23 | 1 |
| DC | $857.55 | 1 |
| DE | $733.61 | 1 |
| FL | $720.83–$784.78 | 3 |
| GA | $678.23–$754.00 | 2 |
| GU | $819.63 | 1 |
| HI | $819.63 | 1 |
| IA | $682.63 | 1 |
| ID | $686.58 | 1 |
| IL | $695.44–$768.03 | 4 |
| IN | $690.99 | 1 |
| KS | $677.24 | 1 |
| KY | $673.08 | 1 |
| LA | $671.16–$707.31 | 2 |
| MA | $773.20–$862.99 | 2 |
| MD | $749.02–$857.55 | 3 |
| ME | $688.38–$731.60 | 2 |
| MI | $690.22–$728.50 | 2 |
| MN | $750.64 | 1 |
| MO | $657.39–$712.38 | 3 |
| MS | $653.96 | 1 |
| MT | $741.48 | 1 |
| NC | $696.47 | 1 |
| ND | $734.36 | 1 |
| NE | $687.26 | 1 |
| NH | $764.89 | 1 |
| NJ | $803.42–$847.18 | 2 |
| NM | $693.52 | 1 |
| NV | $740.10 | 1 |
| NY | $707.57–$874.39 | 5 |
| OH | $688.77 | 1 |
| OK | $673.85 | 1 |
| OR | $735.50–$807.78 | 2 |
| PA | $691.05–$770.92 | 2 |
| PR | $748.00 | 1 |
| RI | $762.56 | 1 |
| SC | $693.55 | 1 |
| SD | $733.52 | 1 |
| TN | $680.67 | 1 |
| TX | $686.00–$775.59 | 8 |
| UT | $703.84 | 1 |
| VA | $727.64–$857.55 | 2 |
| VI | $748.00 | 1 |
| VT | $729.49 | 1 |
| WA | $772.40–$883.25 | 2 |
| WI | $707.68 | 1 |
| WV | $667.14 | 1 |
| WY | $738.37 | 1 |
How the 49442 rate is calculated
Each of 49442’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 · 49442
RVUs × geographic indexes × conversion factor
Work3.66
3.66 RVUs× 1.000 GPCI
Practice expense18.18
18.18 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
22.2000
Conversion factor
$33.4009
Medicare rate
$741.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49442
49442 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49442
Cecostomy tube, percutaneous placement
| 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 · 49442
Cecostomy tube, percutaneous placement
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
49442 without 51 · national office
$741.50
Cecostomy tube, percutaneous placement
49442-51 · Second procedure: 50%
$370.75
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%).
49442 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49440Gastrostomy placementPercutaneous, image-guided
- Choose 49442 for a tube entering the cecum; choose 49440 when the percutaneous tube enters the stomach.
- 49441Enteral tube placementDuodenal or jejunal tube
- Choose 49442 for cecal access. Code 49441 identifies percutaneous placement targeting the duodenum or jejunum.
- 49450Feeding tube replacementGastrostomy or cecostomy
- Use 49442 for new percutaneous cecostomy tube placement; use 49450 when replacing an existing gastrostomy or cecostomy tube.
49442 billing questions
How is this different from percutaneous gastrostomy placement?
This code is for a tube placed into the cecum. Use the gastrostomy code when the tube enters the stomach.
How is this different from duodenal or jejunal tube placement?
The target anatomy controls code selection: this service accesses the cecum, while the related code for duodenal or jejunal placement targets the small bowel.
Can this code be used for replacement of an existing cecostomy tube?
No. This code describes placement of a new tube; code 49450 describes percutaneous replacement of a gastrostomy or cecostomy tube.
Should modifier 50 be reported?
No. A single cecal access is reported once, and modifier 50 is inappropriate for this procedure.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure payment.
When is an assistant payable?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted.
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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