CPT code 49442: Cecostomy tube, percutaneous placement2026 Medicare rate & RVUs in Alabama
Report percutaneous cecostomy tube placement when a clinician establishes image-guided access to the cecum, often for antegrade bowel irrigation.
In Alabama, Medicare pays $660.38 for 49442 in the office and $167.63 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 49442 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How Alabama compares for 49442
Across 109 of 109 payment localities, the office rate for 49442 runs from $650.05 in Arkansas to $1,017.76 in San Benito County, CA. Alabama pays $660.38. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Alabama · this page$660.38
- Los Angeles, CA · California$853.59+$193.21
- Washington, DC area · District of Columbia$857.55+$197.17
- Miami, FL · Florida$784.78+$124.40
- Chicago, IL · Illinois$760.96+$100.58
- Manhattan, NY · New York$854.74+$194.36
- Alaska · Alaska$836.69+$176.31
Other areas in Alabama first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ArkansasArkansas | $650.05 | $166.31 |
| ArizonaArizona | $720.94 | $175.26 |
| Bakersfield, CACalifornia | $797.42 | $180.21 |
| Chico, CACalifornia | $796.29 | $179.09 |
| El Centro, CACalifornia | $796.35 | $179.15 |
| Fresno, CACalifornia | $796.29 | $179.09 |
| Hanford, CACalifornia | $796.29 | $179.09 |
| Madera, CACalifornia | $796.29 | $179.09 |
| Merced, CACalifornia | $796.29 | $179.09 |
| Modesto, CACalifornia | $796.29 | $179.09 |
| Napa, CACalifornia | $936.38 | $194.17 |
| Oxnard, CACalifornia | $850.91 | $185.27 |
| Redding, CACalifornia | $796.29 | $179.09 |
| Rest of CaliforniaCalifornia | $796.29 | $179.09 |
| Riverside, CACalifornia | $800.23 | $183.03 |
| Sacramento, CACalifornia | $839.30 | $184.37 |
| Salinas, CACalifornia | $836.26 | $183.58 |
| San Diego, CACalifornia | $858.68 | $185.16 |
| Marin County, CACalifornia | $995.57 | $201.55 |
| San Francisco, CACalifornia | $995.16 | $201.14 |
| San Benito County, CACalifornia | $1,017.76 | $205.72 |
| Santa Clara County, CACalifornia | $1,016.09 | $204.04 |
| San Luis Obispo, CACalifornia | $822.40 | $180.99 |
| Santa Cruz, CACalifornia | $869.04 | $184.83 |
| Santa Maria, CACalifornia | $840.14 | $183.52 |
| Santa Rosa, CACalifornia | $878.04 | $186.50 |
| Stockton, CACalifornia | $796.29 | $179.09 |
| Vallejo, CACalifornia | $935.80 | $193.58 |
| Visalia, CACalifornia | $796.29 | $179.09 |
| Yuba City, CACalifornia | $796.29 | $179.09 |
| ColoradoColorado | $779.20 | $180.02 |
| ConnecticutConnecticut | $793.23 | $186.73 |
| DelawareDelaware | $733.61 | $177.23 |
| Fort Lauderdale, FLFlorida | $759.11 | $188.65 |
| Rest of FloridaFlorida | $720.83 | $182.47 |
| Atlanta, GAGeorgia | $754.00 | $181.85 |
| Rest of GeorgiaGeorgia | $678.23 | $175.91 |
| Hawaii, Guam, HIHawaii | $819.63 | $179.34 |
| IowaIowa | $682.63 | $167.36 |
| IdahoIdaho | $686.58 | $168.50 |
| East St. Louis, ILIllinois | $705.11 | $187.03 |
| Rest of IllinoisIllinois | $695.44 | $181.29 |
| Suburban Chicago, ILIllinois | $768.03 | $189.69 |
| IndianaIndiana | $690.99 | $168.96 |
| KansasKansas | $677.24 | $168.16 |
| KentuckyKentucky | $673.08 | $172.44 |
| New Orleans, LALouisiana | $707.31 | $177.39 |
| Rest of LouisianaLouisiana | $671.16 | $172.79 |
| Metropolitan Boston, MAMassachusetts | $862.99 | $190.60 |
| Rest of MassachusettsMassachusetts | $773.20 | $180.21 |
| Baltimore area, MDMaryland | $790.63 | $186.39 |
| Rest of MarylandMaryland | $749.02 | $179.13 |
| Rest of MaineMaine | $688.38 | $170.29 |
| Southern Maine, MEMaine | $731.60 | $173.53 |
| Detroit, MIMichigan | $728.50 | $185.07 |
| Rest of MichiganMichigan | $690.22 | $176.08 |
| MinnesotaMinnesota | $750.64 | $171.17 |
| Metropolitan Kansas City, MOMissouri | $704.18 | $175.39 |
| Metropolitan St. Louis, MOMissouri | $712.38 | $176.27 |
| Rest of MissouriMissouri | $657.39 | $171.96 |
| MississippiMississippi | $653.96 | $169.09 |
| MontanaMontana | $741.48 | $178.34 |
| North CarolinaNorth Carolina | $696.47 | $171.07 |
| North DakotaNorth Dakota | $734.36 | $171.22 |
| NebraskaNebraska | $687.26 | $167.49 |
| New HampshireNew Hampshire | $764.89 | $178.67 |
| Northern New JerseyNew Jersey | $847.18 | $193.93 |
| Rest of New JerseyNew Jersey | $803.42 | $188.47 |
| New MexicoNew Mexico | $693.52 | $177.12 |
| NevadaNevada | $740.10 | $176.40 |
| NYC suburbs and Long Island, NYNew York | $874.39 | $204.82 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $807.21 | $190.58 |
| Queens, NYNew York | $865.15 | $199.52 |
| Rest of New YorkNew York | $707.57 | $172.59 |
| OhioOhio | $688.77 | $174.62 |
| OklahomaOklahoma | $673.85 | $170.96 |
| Portland, OROregon | $807.78 | $182.13 |
| Rest of OregonOregon | $735.50 | $174.61 |
| Metropolitan Philadelphia, PAPennsylvania | $770.92 | $184.69 |
| Rest of PennsylvaniaPennsylvania | $691.05 | $174.08 |
| Puerto RicoPuerto Rico | $748.00 | $178.67 |
| Rhode IslandRhode Island | $762.56 | $180.84 |
| South CarolinaSouth Carolina | $693.55 | $173.21 |
| South DakotaSouth Dakota | $733.52 | $170.38 |
| TennesseeTennessee | $680.67 | $168.78 |
| Austin, TXTexas | $775.59 | $179.79 |
| Beaumont, TXTexas | $686.00 | $173.54 |
| Brazoria, TXTexas | $734.37 | $176.30 |
| Dallas, TXTexas | $738.46 | $177.58 |
| Fort Worth, TXTexas | $732.55 | $177.29 |
| Galveston, TXTexas | $736.16 | $176.96 |
| Houston, TXTexas | $742.75 | $183.55 |
| Rest of TexasTexas | $709.36 | $174.95 |
| UtahUtah | $703.84 | $174.49 |
| VirginiaVirginia | $727.64 | $174.08 |
| Virgin Islands, VIUnited States Virgin Islands | $748.00 | $178.67 |
| VermontVermont | $729.49 | $171.98 |
| Rest of WashingtonWashington | $772.40 | $179.41 |
| King County, WAWashington | $883.25 | $192.28 |
| WisconsinWisconsin | $707.68 | $168.19 |
| West VirginiaWest Virginia | $667.14 | $177.77 |
| WyomingWyoming | $738.37 | $175.23 |
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.
The exact Alabama inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,814
- Code
- 49442
- Physician work
- 3.66
- Practice expense
- 18.18
- Malpractice
- 0.36
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.66 | × 1.000 | 3.6600 |
| Practice expense | 18.18 | × 0.875 | 15.9075 |
| Malpractice | 0.36 | × 0.566 | 0.2038 |
| Total RVUs | 19.7713 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Alabama$660.38
Office: (3.66 × 1 + 18.18 × 0.875 + 0.36 × 0.566) × $33.4009 = $660.38
Facility: (3.66 × 1 + 1.32 × 0.875 + 0.36 × 0.566) × $33.4009 = $167.63
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%).
How 49442 has changed in Alabama
49442 · Office / nonfacility
$660.38
Effective 2026-10-01
The base rate is $9.37 higher than on 2025-10-01, moving from $651.01 to $660.38 (1.4%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$651.01changed to$660.38
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.75 changed to 3.66
- Practice expense RVU 18.62 changed to 18.18
- Malpractice RVU 0.34 changed to 0.36
- Practice expense GPCI 0.869 changed to 0.875
- Malpractice GPCI 0.575 changed to 0.566
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$689.43changed to$651.01
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 19.30 changed to 18.62
- Malpractice RVU 0.33 changed to 0.34
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$678.18changed to$689.43
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$729.99changed to$678.18
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 20.00 changed to 19.30
- Malpractice RVU 0.31 changed to 0.33
- Practice expense GPCI 0.878 changed to 0.869
- Malpractice GPCI 0.748 changed to 0.575
January 1, 2023
RVU23A
$770.24changed to$729.99
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 20.52 changed to 20.00
- Practice expense GPCI 0.888 changed to 0.878
- Malpractice GPCI 0.921 changed to 0.748
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$817.51changed to$770.24
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 21.85 changed to 20.52
- Malpractice RVU 0.30 changed to 0.31
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$822.52changed to$817.51
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 21.18 changed to 21.85
- Practice expense GPCI 0.889 changed to 0.888
- Malpractice GPCI 0.707 changed to 0.921
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$827.72changed to$822.52
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 21.41 changed to 21.18
- Malpractice RVU 0.33 changed to 0.30
- Practice expense GPCI 0.890 changed to 0.889
- Malpractice GPCI 0.492 changed to 0.707
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$838.49changed to$827.72
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 21.78 changed to 21.41
- Malpractice RVU 0.32 changed to 0.33
Held through RVU19B, RVU19C, RVU19D.
April 1, 2018
RVU18B
No ratechanged to$838.49
Held through RVU18C, RVU18D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $660.38 | $167.63 | RVU26D |
| 2026-07-01 | $660.38 | $167.63 | RVU26C |
| 2026-04-01 | $660.38 | $167.63 | RVU26B |
| 2026-01-01 | $660.38 | $167.63 | RVU26A |
| 2025-10-01 | $651.01 | $184.97 | RVU25D |
| 2025-07-01 | $651.01 | $184.97 | RVU25C |
| 2025-04-01 | $651.01 | $184.97 | RVU25B |
| 2025-01-01 | $651.01 | $184.97 | RVU25A |
| 2024-10-01 | $689.43 | $188.42 | RVU24D |
| 2024-07-01 | $689.43 | $188.42 | RVU24C |
| 2024-04-01 | $689.43 | $188.42 | RVU24B |
| 2024-03-09 | $689.43 | $188.42 | RVU24AR |
| 2024-01-01 | $678.18 | $185.34 | RVU24A |
| 2023-10-01 | $729.99 | $194.14 | RVU23D |
| 2023-07-01 | $729.99 | $194.14 | RVU23C |
| 2023-04-01 | $729.99 | $194.14 | RVU23B |
| 2023-01-01 | $729.99 | $194.14 | RVU23A |
| 2022-10-01 | $770.24 | $198.96 | RVU22D |
| 2022-07-01 | $770.24 | $198.96 | RVU22C |
| 2022-04-01 | $770.24 | $198.96 | RVU22B |
| 2022-01-01 | $770.24 | $198.96 | RVU22A |
| 2021-10-01 | $817.51 | $199.98 | RVU21D |
| 2021-07-01 | $817.51 | $199.98 | RVU21C |
| 2021-04-01 | $817.51 | $199.98 | RVU21B |
| 2021-01-01 | $817.51 | $199.98 | RVU21A |
| 2020-10-01 | $822.52 | $205.55 | RVU20D |
| 2020-07-01 | $822.52 | $205.55 | RVU20C |
| 2020-04-01 | $822.52 | $205.55 | RVU20B |
| 2020-01-01 | $822.52 | $205.55 | RVU20A |
| 2019-10-01 | $827.72 | $203.86 | RVU19D |
| 2019-07-01 | $827.72 | $203.86 | RVU19C |
| 2019-04-01 | $827.72 | $203.86 | RVU19B |
| 2019-01-01 | $827.72 | $203.86 | RVU19A |
| 2018-10-01 | $838.49 | $203.78 | RVU18D |
| 2018-07-01 | $838.49 | $203.78 | RVU18C |
| 2018-04-01 | $838.49 | $203.78 | RVU18B |
| 2018-01-01 | Rate data unavailable | Rate data unavailable | RVU18AR1 |
| 2017-10-01 | Rate data unavailable | Rate data unavailable | RVU17D |
| 2017-07-01 | Rate data unavailable | Rate data unavailable | RVU17C |
| 2017-04-01 | Rate data unavailable | Rate data unavailable | RVU17B |
| 2017-01-01 | Rate data unavailable | Rate data unavailable | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Alabama rate applies
Alabama is a Medicare payment area, not a city. Our Census mapping connects it to 595 cities and communities in Alabama. Some span more than one payment area; confirm with the service ZIP.
- Abanda
- Abbeville
- Adamsville
- Addison
- Akron
- Alabaster
- Albertville
- Alexander City
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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