CPT code 49446: Tube conversion, G-tube to G-J tube2026 Medicare rate & RVUs in Vallejo, CA
Reports fluoroscopic conversion of an established gastrostomy into gastrojejunal access when post-pyloric tube delivery is needed through the existing tract.
In Vallejo, CA, Medicare pays $970.93 for 49446 in the office and $130.98 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 49446 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 49446 covers
This service converts an established percutaneous gastrostomy access into gastrojejunal access by passing a tube through the existing gastric tract and positioning its distal end in the small bowel under fluoroscopic guidance. It is typically performed by an interventional radiologist when post-pyloric delivery is needed, including when gastric feeding is not tolerated. Contrast injection and fluoroscopic confirmation of tube position are part of the documented procedure.
Report 49446 for conversion, rather than simply exchanging a G-J tube or replacing a G-tube with another gastric tube. Documentation should identify the existing gastrostomy, the conversion performed, relevant imaging or contrast findings, and the final tube position. The 0-day global period includes same-day preoperative and postoperative care. When another procedure in the same session is subject to the multiple procedure rule, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery 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 Vallejo, CA compares for 49446
Across 109 of 109 payment localities, the office rate for 49446 runs from $665.90 in Arkansas to $1,057.39 in San Benito County, CA. Vallejo, CA pays $970.93. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Vallejo, CA · this page$970.93
- Bakersfield, CA · California$823.49−$147.44
- Chico, CA · California$822.44−$148.49
- El Centro, CA · California$822.49−$148.44
- Fresno, CA · California$822.44−$148.49
- Hanford, CA · California$822.44−$148.49
- Los Angeles, CA · California$883.07−$87.86
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $822.44 | $123.97 |
| Merced, CACalifornia | $822.44 | $123.97 |
| Modesto, CACalifornia | $822.44 | $123.97 |
| Napa, CACalifornia | $971.50 | $131.55 |
| Oxnard, CACalifornia | $880.65 | $127.37 |
| Redding, CACalifornia | $822.44 | $123.97 |
| Rest of CaliforniaCalifornia | $822.44 | $123.97 |
| Riverside, CACalifornia | $826.24 | $127.77 |
| Sacramento, CACalifornia | $868.03 | $126.86 |
| Salinas, CACalifornia | $864.92 | $126.31 |
| San Diego, CACalifornia | $889.03 | $126.83 |
| Marin County, CACalifornia | $1,034.13 | $135.55 |
| San Francisco, CACalifornia | $1,033.73 | $135.15 |
| San Benito County, CACalifornia | $1,057.39 | $138.42 |
| Santa Clara County, CACalifornia | $1,055.77 | $136.80 |
| San Luis Obispo, CACalifornia | $850.48 | $124.61 |
| Santa Cruz, CACalifornia | $900.46 | $126.15 |
| Santa Maria, CACalifornia | $869.19 | $126.11 |
| Santa Rosa, CACalifornia | $909.84 | $127.24 |
| Stockton, CACalifornia | $822.44 | $123.97 |
| Visalia, CACalifornia | $822.44 | $123.97 |
| Yuba City, CACalifornia | $822.44 | $123.97 |
| Washington, DC areaDistrict of Columbia | $886.35 | $135.63 |
| Miami, FLFlorida | $808.16 | $144.75 |
| Chicago, ILIllinois | $782.64 | $142.17 |
| Manhattan, NYNew York | $882.44 | $141.91 |
| AlaskaAlaska | $850.46 | $171.75 |
| AlabamaAlabama | $676.93 | $119.30 |
| ArkansasArkansas | $665.90 | $118.47 |
| ArizonaArizona | $741.64 | $124.11 |
| ColoradoColorado | $803.93 | $125.85 |
| ConnecticutConnecticut | $818.22 | $131.86 |
| DelawareDelaware | $755.03 | $125.39 |
| Fort Lauderdale, FLFlorida | $781.47 | $135.90 |
| Rest of FloridaFlorida | $740.72 | $131.47 |
| Atlanta, GAGeorgia | $776.63 | $129.14 |
| Rest of GeorgiaGeorgia | $695.34 | $126.88 |
| Hawaii, Guam, HIHawaii | $847.99 | $123.39 |
| IowaIowa | $701.05 | $117.93 |
| IdahoIdaho | $705.20 | $118.89 |
| East St. Louis, ILIllinois | $723.21 | $136.91 |
| Rest of IllinoisIllinois | $713.37 | $131.53 |
| Suburban Chicago, ILIllinois | $790.88 | $136.38 |
| IndianaIndiana | $709.92 | $119.15 |
| KansasKansas | $695.12 | $119.01 |
| KentuckyKentucky | $690.14 | $123.59 |
| New Orleans, LALouisiana | $726.65 | $126.96 |
| Rest of LouisianaLouisiana | $688.04 | $124.04 |
| Metropolitan Boston, MAMassachusetts | $892.89 | $131.97 |
| Rest of MassachusettsMassachusetts | $797.34 | $126.27 |
| Baltimore area, MDMaryland | $815.53 | $131.72 |
| Rest of MarylandMaryland | $771.41 | $126.47 |
| Rest of MaineMaine | $706.94 | $120.63 |
| Southern Maine, MEMaine | $753.36 | $121.81 |
| Detroit, MIMichigan | $748.73 | $133.75 |
| Rest of MichiganMichigan | $708.30 | $126.46 |
| MinnesotaMinnesota | $774.23 | $118.46 |
| Metropolitan Kansas City, MOMissouri | $723.48 | $125.07 |
| Metropolitan St. Louis, MOMissouri | $732.26 | $125.56 |
| Rest of MissouriMissouri | $673.22 | $123.88 |
| MississippiMississippi | $669.82 | $121.12 |
| MontanaMontana | $763.52 | $126.23 |
| North CarolinaNorth Carolina | $715.62 | $121.03 |
| North DakotaNorth Dakota | $756.60 | $119.31 |
| NebraskaNebraska | $706.04 | $117.83 |
| New HampshireNew Hampshire | $788.83 | $125.41 |
| Northern New JerseyNew Jersey | $874.98 | $135.73 |
| Rest of New JerseyNew Jersey | $828.67 | $132.75 |
| New MexicoNew Mexico | $711.75 | $127.36 |
| NevadaNevada | $762.24 | $124.32 |
| NYC suburbs and Long Island, NYNew York | $903.22 | $145.48 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $832.45 | $134.62 |
| Queens, NYNew York | $893.80 | $140.53 |
| Rest of New YorkNew York | $727.46 | $122.03 |
| OhioOhio | $706.89 | $125.04 |
| OklahomaOklahoma | $691.14 | $122.04 |
| Portland, OROregon | $834.55 | $126.52 |
| Rest of OregonOregon | $757.46 | $122.72 |
| Metropolitan Philadelphia, PAPennsylvania | $794.34 | $130.92 |
| Rest of PennsylvaniaPennsylvania | $709.41 | $124.38 |
| Puerto RicoPuerto Rico | $770.54 | $126.25 |
| Rhode IslandRhode Island | $785.70 | $127.38 |
| South CarolinaSouth Carolina | $712.21 | $123.36 |
| South DakotaSouth Dakota | $755.78 | $118.49 |
| TennesseeTennessee | $698.77 | $119.48 |
| Austin, TXTexas | $800.25 | $125.99 |
| Beaumont, TXTexas | $704.01 | $124.07 |
| Brazoria, TXTexas | $755.90 | $124.34 |
| Dallas, TXTexas | $760.17 | $125.43 |
| Fort Worth, TXTexas | $753.80 | $125.43 |
| Galveston, TXTexas | $757.76 | $124.94 |
| Houston, TXTexas | $764.17 | $131.34 |
| Rest of TexasTexas | $729.14 | $124.35 |
| UtahUtah | $723.21 | $124.16 |
| VirginiaVirginia | $749.02 | $122.56 |
| Virgin Islands, VIUnited States Virgin Islands | $770.54 | $126.25 |
| VermontVermont | $751.25 | $120.33 |
| Rest of WashingtonWashington | $796.62 | $125.55 |
| King County, WAWashington | $914.46 | $132.50 |
| WisconsinWisconsin | $728.06 | $117.53 |
| West VirginiaWest Virginia | $683.13 | $129.32 |
| WyomingWyoming | $760.51 | $123.22 |
49446 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.
$665.90
$939.92
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 | $850.46 | 1 |
| AL | $676.93 | 1 |
| AR | $665.90 | 1 |
| AZ | $741.64 | 1 |
| CA | $822.44–$1,057.39 | 29 |
| CO | $803.93 | 1 |
| CT | $818.22 | 1 |
| DC | $886.35 | 1 |
| DE | $755.03 | 1 |
| FL | $740.72–$808.16 | 3 |
| GA | $695.34–$776.63 | 2 |
| GU | $847.99 | 1 |
| HI | $847.99 | 1 |
| IA | $701.05 | 1 |
| ID | $705.20 | 1 |
| IL | $713.37–$790.88 | 4 |
| IN | $709.92 | 1 |
| KS | $695.12 | 1 |
| KY | $690.14 | 1 |
| LA | $688.04–$726.65 | 2 |
| MA | $797.34–$892.89 | 2 |
| MD | $771.41–$886.35 | 3 |
| ME | $706.94–$753.36 | 2 |
| MI | $708.30–$748.73 | 2 |
| MN | $774.23 | 1 |
| MO | $673.22–$732.26 | 3 |
| MS | $669.82 | 1 |
| MT | $763.52 | 1 |
| NC | $715.62 | 1 |
| ND | $756.60 | 1 |
| NE | $706.04 | 1 |
| NH | $788.83 | 1 |
| NJ | $828.67–$874.98 | 2 |
| NM | $711.75 | 1 |
| NV | $762.24 | 1 |
| NY | $727.46–$903.22 | 5 |
| OH | $706.89 | 1 |
| OK | $691.14 | 1 |
| OR | $757.46–$834.55 | 2 |
| PA | $709.41–$794.34 | 2 |
| PR | $770.54 | 1 |
| RI | $785.70 | 1 |
| SC | $712.21 | 1 |
| SD | $755.78 | 1 |
| TN | $698.77 | 1 |
| TX | $704.01–$800.25 | 8 |
| UT | $723.21 | 1 |
| VA | $749.02–$886.35 | 2 |
| VI | $770.54 | 1 |
| VT | $751.25 | 1 |
| WA | $796.62–$914.46 | 2 |
| WI | $728.06 | 1 |
| WV | $683.13 | 1 |
| WY | $760.51 | 1 |
How the 49446 rate is calculated
Each of 49446’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 · 49446
RVUs × geographic indexes × conversion factor
Work2.98
2.98 RVUs× 1.000 GPCI
Practice expense19.53
19.53 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
22.8600
Conversion factor
$33.4009
Medicare rate
$763.54
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Vallejo, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,815
- Code
- 49446
- Physician work
- 2.98
- Practice expense
- 19.53
- Malpractice
- 0.35
GPCI2026.csv
33
- Locality
- Vallejo, CA
- Physician work
- 1.063
- Practice expense
- 1.318
- Malpractice
- 0.459
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.98 | × 1.063 | 3.1677 |
| Practice expense | 19.53 | × 1.318 | 25.7405 |
| Malpractice | 0.35 | × 0.459 | 0.1606 |
| Total RVUs | 29.0689 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Vallejo, CA$970.93
Office: (2.98 × 1.063 + 19.53 × 1.318 + 0.35 × 0.459) × $33.4009 = $970.93
Facility: (2.98 × 1.063 + 0.45 × 1.318 + 0.35 × 0.459) × $33.4009 = $130.98
Payment rules and modifiers for 49446
The CMS indicators that decide how 49446 is paid alongside other services.
CMS payment indicators · 49446
Tube conversion, G-tube to G-J tube
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49446 without 51 · national office
$763.54
Tube conversion, G-tube to G-J tube
49446-51 · Second procedure: 50%
$381.77
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 49446 has changed in Vallejo, CA
49446 · Office / nonfacility
$970.93
Effective 2026-10-01
The base rate is $32.36 higher than on 2025-10-01, moving from $938.57 to $970.93 (3.4%).
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
$938.57changed to$970.93
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.06 changed to 2.98
- Practice expense RVU 19.56 changed to 19.53
- Malpractice RVU 0.33 changed to 0.35
- Work GPCI 1.058 changed to 1.063
- Practice expense GPCI 1.310 changed to 1.318
- Malpractice GPCI 0.470 changed to 0.459
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$990.30changed to$938.57
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 20.12 changed to 19.56
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$974.13changed to$990.30
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$1006.60changed to$974.13
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 20.82 changed to 20.12
- Malpractice RVU 0.31 changed to 0.33
- Work GPCI 1.051 changed to 1.058
- Practice expense GPCI 1.265 changed to 1.310
- Malpractice GPCI 0.487 changed to 0.470
January 1, 2023
RVU23A
$1018.51changed to$1006.60
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 21.39 changed to 20.82
- Malpractice RVU 0.28 changed to 0.31
- Work GPCI 1.044 changed to 1.051
- Practice expense GPCI 1.220 changed to 1.265
- Malpractice GPCI 0.504 changed to 0.487
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$1089.61changed to$1018.51
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 22.87 changed to 21.39
- Malpractice RVU 0.26 changed to 0.28
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$1116.13changed to$1089.61
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 22.28 changed to 22.87
- Malpractice RVU 0.27 changed to 0.26
- Work GPCI 1.049 changed to 1.044
- Practice expense GPCI 1.238 changed to 1.220
- Malpractice GPCI 0.496 changed to 0.504
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$1144.70changed to$1116.13
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 22.62 changed to 22.28
- Work GPCI 1.055 changed to 1.049
- Practice expense GPCI 1.256 changed to 1.238
- Malpractice GPCI 0.458 changed to 0.496
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$1166.96changed to$1144.70
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 23.14 changed to 22.62
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$1174.57changed to$1166.96
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 23.10 changed to 23.14
- Malpractice RVU 0.28 changed to 0.27
- Work GPCI 1.057 changed to 1.055
- Practice expense GPCI 1.271 changed to 1.256
- Malpractice GPCI 0.477 changed to 0.458
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$1174.57
Held through RVU17B, RVU17C, RVU17D.
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.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $970.93 | $130.98 | RVU26D |
| 2026-07-01 | $970.93 | $130.98 | RVU26C |
| 2026-04-01 | $970.93 | $130.98 | RVU26B |
| 2026-01-01 | $970.93 | $130.98 | RVU26A |
| 2025-10-01 | $938.57 | $148.30 | RVU25D |
| 2025-07-01 | $938.57 | $148.30 | RVU25C |
| 2025-04-01 | $938.57 | $148.30 | RVU25B |
| 2025-01-01 | $938.57 | $148.30 | RVU25A |
| 2024-10-01 | $990.30 | $150.87 | RVU24D |
| 2024-07-01 | $990.30 | $150.87 | RVU24C |
| 2024-04-01 | $990.30 | $150.87 | RVU24B |
| 2024-03-09 | $990.30 | $150.87 | RVU24AR |
| 2024-01-01 | $974.13 | $148.41 | RVU24A |
| 2023-10-01 | $1,006.60 | $153.11 | RVU23D |
| 2023-07-01 | $1,006.60 | $153.11 | RVU23C |
| 2023-04-01 | $1,006.60 | $153.11 | RVU23B |
| 2023-01-01 | $1,006.60 | $153.11 | RVU23A |
| 2022-10-01 | $1,018.51 | $153.86 | RVU22D |
| 2022-07-01 | $1,018.51 | $153.86 | RVU22C |
| 2022-04-01 | $1,018.51 | $153.86 | RVU22B |
| 2022-01-01 | $1,018.51 | $153.86 | RVU22A |
| 2021-10-01 | $1,089.61 | $155.63 | RVU21D |
| 2021-07-01 | $1,089.61 | $155.63 | RVU21C |
| 2021-04-01 | $1,089.61 | $155.63 | RVU21B |
| 2021-01-01 | $1,089.61 | $155.63 | RVU21A |
| 2020-10-01 | $1,116.13 | $164.02 | RVU20D |
| 2020-07-01 | $1,116.13 | $164.02 | RVU20C |
| 2020-04-01 | $1,116.13 | $164.02 | RVU20B |
| 2020-01-01 | $1,116.13 | $164.02 | RVU20A |
| 2019-10-01 | $1,144.70 | $164.71 | RVU19D |
| 2019-07-01 | $1,144.70 | $164.71 | RVU19C |
| 2019-04-01 | $1,144.70 | $164.71 | RVU19B |
| 2019-01-01 | $1,144.70 | $164.71 | RVU19A |
| 2018-10-01 | $1,166.96 | $164.98 | RVU18D |
| 2018-07-01 | $1,166.96 | $164.98 | RVU18C |
| 2018-04-01 | $1,166.96 | $164.98 | RVU18B |
| 2018-01-01 | $1,166.96 | $164.98 | RVU18AR1 |
| 2017-10-01 | $1,174.57 | $166.94 | RVU17D |
| 2017-07-01 | $1,174.57 | $166.94 | RVU17C |
| 2017-04-01 | $1,174.57 | $166.94 | RVU17B |
| 2017-01-01 | $1,174.57 | $166.94 | 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 Vallejo, CA rate applies
Vallejo, CA is a Medicare payment area, not a city. Our Census mapping connects it to 11 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Vallejo
- Allendale
- Benicia
- Dixon
- Elmira
- Fairfield
- Green Valley
- Hartley
49446 billing questions
When should I report 49446 instead of 49452?
Use 49446 to convert an existing gastrostomy to gastrojejunal access. Use 49452 when replacing an existing G-J tube.
Can fluoroscopy or contrast be billed separately?
Fluoroscopic guidance, contrast injection, image documentation, and the report are included in the conversion service.
Should modifier 50 be appended?
No. Bilateral adjustment is inappropriate for this service. The CMS multiple procedure reduction may apply when other procedures are performed in the same session.
What documentation supports reporting 49446?
Document the existing gastrostomy access, the conversion to gastrojejunal access, imaging or contrast findings, and the final tube position.
Can an assistant surgeon be paid for this procedure?
Assistant-at-surgery payment is permitted only when medical necessity is documented. 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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