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CPT code 49442: Cecostomy tube, percutaneous placement2026 Medicare rate & RVUs in Puerto Rico

Report percutaneous cecostomy tube placement when a clinician establishes image-guided access to the cecum, often for antegrade bowel irrigation.

CMS RVU26DEffective Oct 1, 2026One payment locality31 Medicare services in 2024

In Puerto Rico, Medicare pays $748.00 for 49442 in the office and $178.67 when it’s performed in a hospital or facility.

$748.00Office (non-facility)
$178.67Hospital or facility
+0.9%vs the national office rate ($741.50)

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.

We’ll open 49442 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 49442 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 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 Puerto Rico 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. Puerto Rico pays $748.00. The RVUs are the same everywhere; the geographic indexes change the dollars.

49442 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$748.00
  2. Los Angeles, CA · California$853.59+$105.59
  3. Washington, DC area · District of Columbia$857.55+$109.55
  4. Miami, FL · Florida$784.78+$36.78
  5. Chicago, IL · Illinois$760.96+$12.96
  6. Manhattan, NY · New York$854.74+$106.74
  7. Alaska · Alaska$836.69+$88.69

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

49442 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$660.38$167.63
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

49442 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.

$650.05

$907.03

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

View every state and territory as a table
49442 office rate range by state
State / territoryOffice rate rangeLocalities
AK$836.691
AL$660.381
AR$650.051
AZ$720.941
CA$796.29–$1,017.7629
CO$779.201
CT$793.231
DC$857.551
DE$733.611
FL$720.83–$784.783
GA$678.23–$754.002
GU$819.631
HI$819.631
IA$682.631
ID$686.581
IL$695.44–$768.034
IN$690.991
KS$677.241
KY$673.081
LA$671.16–$707.312
MA$773.20–$862.992
MD$749.02–$857.553
ME$688.38–$731.602
MI$690.22–$728.502
MN$750.641
MO$657.39–$712.383
MS$653.961
MT$741.481
NC$696.471
ND$734.361
NE$687.261
NH$764.891
NJ$803.42–$847.182
NM$693.521
NV$740.101
NY$707.57–$874.395
OH$688.771
OK$673.851
OR$735.50–$807.782
PA$691.05–$770.922
PR$748.001
RI$762.561
SC$693.551
SD$733.521
TN$680.671
TX$686.00–$775.598
UT$703.841
VA$727.64–$857.552
VI$748.001
VT$729.491
WA$772.40–$883.252
WI$707.681
WV$667.141
WY$738.371

See 49442 in every payment locality

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

Office or facility?

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 49442 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work3.66× 1.0003.6600
Practice expense18.18× 1.01118.3800
Malpractice0.36× 0.9850.3546
Total RVUs22.3946
Conversion factor× 33.4009

Office rate, Puerto Rico$748.00

Office: (3.66 × 1 + 18.18 × 1.011 + 0.36 × 0.985) × $33.4009 = $748.00

Facility: (3.66 × 1 + 1.32 × 1.011 + 0.36 × 0.985) × $33.4009 = $178.67

Open 49442 in the RVU calculator

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

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 · 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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%).

When to use modifier 51

Codes related to 49442

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

Codes related to 49442
CodeHow it relatesOffice range, Puerto Rico
Same family
49440Gastrostomy placement, percutaneous, image-guidedPercutaneous tube placement in the stomach rather than the cecum.$795.15
49441Enteral tube placement, duodenal or jejunal tubePercutaneous tube placement in the duodenum or jejunum rather than the cecum.$990.21
Used instead
49450Feeding tube replacement, gastrostomy or cecostomyUsed for percutaneous replacement of an existing gastrostomy or cecostomy tube.$569.73

How 49442 has changed in Puerto Rico

49442 · Office / nonfacility

$748.00

Effective 2026-10-01

The base rate is $9.39 higher than on 2025-10-01, moving from $738.61 to $748.00 (1.3%).

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

    $738.61changed to$748.00

    • 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 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $782.56changed to$738.61

    • 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.

  3. March 9, 2024

    RVU24AR

    $769.79changed to$782.56

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $820.58changed to$769.79

    • 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 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $815.33changed to$820.58

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $856.15changed to$815.33

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 20.52 changed to 20.00
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $909.68changed to$856.15

    • 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.

  8. January 1, 2021

    RVU21A

    $916.53changed to$909.68

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 21.18 changed to 21.85
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $923.92changed to$916.53

    • 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 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $935.96changed to$923.92

    • 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.

  11. January 1, 2018

    RVU18AR1

    $810.67changed to$935.96

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 21.76 changed to 21.78
    • Malpractice RVU 0.33 changed to 0.32
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $732.36changed to$810.67

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 4.00 changed to 3.75
    • Practice expense RVU 23.19 changed to 21.76
    • Malpractice RVU 0.36 changed to 0.33
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $734.45changed to$732.36

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 23.16 changed to 23.19
    • Malpractice RVU 0.38 changed to 0.36

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $730.80changed to$734.45

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $710.65changed to$730.80

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 22.75 changed to 23.16
    • Malpractice RVU 0.35 changed to 0.38
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $698.85changed to$710.65

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 24.26 changed to 22.75
    • Malpractice RVU 0.37 changed to 0.35
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $698.85

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$748.00$178.67RVU26D
2026-07-01$748.00$178.67RVU26C
2026-04-01$748.00$178.67RVU26B
2026-01-01$748.00$178.67RVU26A
2025-10-01$738.61$198.55RVU25D
2025-07-01$738.61$198.55RVU25C
2025-04-01$738.61$198.55RVU25B
2025-01-01$738.61$198.55RVU25A
2024-10-01$782.56$201.99RVU24D
2024-07-01$782.56$201.99RVU24C
2024-04-01$782.56$201.99RVU24B
2024-03-09$782.56$201.99RVU24AR
2024-01-01$769.79$198.69RVU24A
2023-10-01$820.58$205.39RVU23D
2023-07-01$815.33$205.02RVU23C
2023-04-01$815.33$205.02RVU23B
2023-01-01$815.33$205.02RVU23A
2022-10-01$856.15$207.68RVU22D
2022-07-01$856.15$207.68RVU22C
2022-04-01$856.15$207.68RVU22B
2022-01-01$856.15$207.68RVU22A
2021-10-01$909.68$208.70RVU21D
2021-07-01$909.68$208.70RVU21C
2021-04-01$909.68$208.70RVU21B
2021-01-01$909.68$208.70RVU21A
2020-10-01$916.53$216.97RVU20D
2020-07-01$916.53$216.97RVU20C
2020-04-01$916.53$216.97RVU20B
2020-01-01$916.53$216.97RVU20A
2019-10-01$923.92$218.05RVU19D
2019-07-01$923.92$218.05RVU19C
2019-04-01$923.92$218.05RVU19B
2019-01-01$923.92$218.05RVU19A
2018-10-01$935.96$217.82RVU18D
2018-07-01$935.96$217.82RVU18C
2018-04-01$935.96$217.82RVU18B
2018-01-01$935.96$217.82RVU18AR1
2017-10-01$810.67$203.32RVU17D
2017-07-01$810.67$203.32RVU17C
2017-04-01$810.67$203.32RVU17B
2017-01-01$810.67$203.32RVU17A
2016-10-01$732.36$199.24RVU16D
2016-07-01$732.36$199.24RVU16C
2016-04-01$732.36$199.24RVU16B
2016-01-01$732.36$199.24RVU16A
2015-10-01$734.45$200.68RVU15D
2015-07-01$734.45$200.68RVU15C
2015-04-01$730.80$199.68RVU15B
2015-01-01$730.80$199.68RVU15A
2014-10-01$710.65$197.26RVU14D
2014-07-01$710.65$197.26RVU14C
2014-04-01$710.65$197.26RVU14B
2014-01-01$710.65$197.26RVU14A
2013-10-01$698.85$186.75RVU13D
2013-07-01$698.85$186.75RVU13C
2013-04-01$698.85$186.75RVU13B
2013-01-01$698.85$186.75RVU13AR

Price 49442 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 49442PPRRVU2026_Oct_nonQPP.csv, line 5,814 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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