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CPT code 49446: Tube conversion, G-tube to G-J tube2026 Medicare rate & RVUs in Connecticut

Reports fluoroscopic conversion of an established gastrostomy into gastrojejunal access when post-pyloric tube delivery is needed through the existing tract.

CMS RVU26DEffective Oct 1, 2026One payment locality3.1K Medicare services in 2024

In Connecticut, Medicare pays $818.22 for 49446 in the office and $131.86 when it’s performed in a hospital or facility.

$818.22Office (non-facility)
$131.86Hospital or facility
+7.2%vs the national office rate ($763.54)

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.

We’ll open 49446 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Connecticut
  2. What 49446 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 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 Connecticut 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. Connecticut pays $818.22. The RVUs are the same everywhere; the geographic indexes change the dollars.

49446 in Connecticut vs other payment areas
  1. Connecticut · this page$818.22
  2. Los Angeles, CA · California$883.07+$64.85
  3. Washington, DC area · District of Columbia$886.35+$68.13
  4. Miami, FL · Florida$808.16−$10.06
  5. Chicago, IL · Illinois$782.64−$35.58
  6. Manhattan, NY · New York$882.44+$64.22
  7. Alaska · Alaska$850.46+$32.24

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

Every other payment area

49446 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$676.93$119.30
ArkansasArkansas$665.90$118.47
ArizonaArizona$741.64$124.11
Bakersfield, CACalifornia$823.49$125.02
Chico, CACalifornia$822.44$123.97
El Centro, CACalifornia$822.49$124.02
Fresno, CACalifornia$822.44$123.97
Hanford, CACalifornia$822.44$123.97

49446 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.

$665.90

$939.92

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

View every state and territory as a table
49446 office rate range by state
State / territoryOffice rate rangeLocalities
AK$850.461
AL$676.931
AR$665.901
AZ$741.641
CA$822.44–$1,057.3929
CO$803.931
CT$818.221
DC$886.351
DE$755.031
FL$740.72–$808.163
GA$695.34–$776.632
GU$847.991
HI$847.991
IA$701.051
ID$705.201
IL$713.37–$790.884
IN$709.921
KS$695.121
KY$690.141
LA$688.04–$726.652
MA$797.34–$892.892
MD$771.41–$886.353
ME$706.94–$753.362
MI$708.30–$748.732
MN$774.231
MO$673.22–$732.263
MS$669.821
MT$763.521
NC$715.621
ND$756.601
NE$706.041
NH$788.831
NJ$828.67–$874.982
NM$711.751
NV$762.241
NY$727.46–$903.225
OH$706.891
OK$691.141
OR$757.46–$834.552
PA$709.41–$794.342
PR$770.541
RI$785.701
SC$712.211
SD$755.781
TN$698.771
TX$704.01–$800.258
UT$723.211
VA$749.02–$886.352
VI$770.541
VT$751.251
WA$796.62–$914.462
WI$728.061
WV$683.131
WY$760.511

See 49446 in every payment locality

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

Office or facility?

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 Connecticut 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

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Office calculation for 49446 in Connecticut
ComponentRVULocality factorAdjusted
Physician work2.98× 1.0203.0396
Practice expense19.53× 1.07721.0338
Malpractice0.35× 1.2100.4235
Total RVUs24.4969
Conversion factor× 33.4009

Office rate, Connecticut$818.22

Office: (2.98 × 1.02 + 19.53 × 1.077 + 0.35 × 1.21) × $33.4009 = $818.22

Facility: (2.98 × 1.02 + 0.45 × 1.077 + 0.35 × 1.21) × $33.4009 = $131.86

Open 49446 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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.

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%).

When to use modifier 51

Codes related to 49446

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

Codes related to 49446
CodeHow it relatesOffice range, Connecticut
Used instead
49452G-J tube replacement, percutaneous exchangeUsed to replace an existing G-J tube rather than convert a gastrostomy to G-J access.$779.51
49450Feeding tube replacement, gastrostomy or cecostomyUsed when replacing a gastrostomy tube while retaining gastric access.$605.71
49440Gastrostomy placement, percutaneous, image-guidedReports percutaneous placement of gastrostomy access rather than conversion of an existing tract.$843.58
49441Enteral tube placement, duodenal or jejunal tubeReports percutaneous placement of duodenal or jejunal access rather than conversion through a gastrostomy.$1,052.00

How 49446 has changed in Connecticut

49446 · Office / nonfacility

$818.22

Effective 2026-10-01

The base rate is $13.91 higher than on 2025-10-01, moving from $804.31 to $818.22 (1.7%).

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

    $804.31changed to$818.22

    • 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 1.022 changed to 1.020
    • Practice expense GPCI 1.091 changed to 1.077
    • Malpractice GPCI 1.207 changed to 1.210

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $848.05changed to$804.31

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 20.12 changed to 19.56

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $834.21changed to$848.05

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $895.54changed to$834.21

    • 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 1.030 changed to 1.022
    • Practice expense GPCI 1.102 changed to 1.091
    • Malpractice GPCI 1.070 changed to 1.207

  5. January 1, 2023

    RVU23A

    $943.48changed to$895.54

    • 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 1.037 changed to 1.030
    • Practice expense GPCI 1.114 changed to 1.102
    • Malpractice GPCI 0.934 changed to 1.070

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1008.17changed to$943.48

    • 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.

  7. January 1, 2021

    RVU21A

    $1019.23changed to$1008.17

    • 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 1.029 changed to 1.037
    • Practice expense GPCI 1.113 changed to 1.114
    • Malpractice GPCI 1.094 changed to 0.934

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $1031.31changed to$1019.23

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 22.62 changed to 22.28
    • Work GPCI 1.021 changed to 1.029
    • Practice expense GPCI 1.112 changed to 1.113
    • Malpractice GPCI 1.255 changed to 1.094

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $1051.00changed to$1031.31

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 23.14 changed to 22.62

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $1050.87changed to$1051.00

    • 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 1.023 changed to 1.021
    • Practice expense GPCI 1.117 changed to 1.112
    • Malpractice GPCI 1.244 changed to 1.255

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1133.59changed to$1050.87

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.31 changed to 3.06
    • Practice expense RVU 24.89 changed to 23.10
    • Malpractice RVU 0.30 changed to 0.28
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.121 changed to 1.117
    • Malpractice GPCI 1.232 changed to 1.244

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1135.79changed to$1133.59

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 24.81 changed to 24.89
    • Malpractice RVU 0.33 changed to 0.30

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $1130.13changed to$1135.79

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1124.54changed to$1130.13

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 24.76 changed to 24.81
    • Malpractice RVU 0.30 changed to 0.33
    • Practice expense GPCI 1.116 changed to 1.121
    • Malpractice GPCI 1.234 changed to 1.232

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $1141.97changed to$1124.54

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 26.84 changed to 24.76
    • Malpractice RVU 0.31 changed to 0.30
    • Practice expense GPCI 1.110 changed to 1.116
    • Malpractice GPCI 1.235 changed to 1.234

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $1141.97

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$818.22$131.86RVU26D
2026-07-01$818.22$131.86RVU26C
2026-04-01$818.22$131.86RVU26B
2026-01-01$818.22$131.86RVU26A
2025-10-01$804.31$146.16RVU25D
2025-07-01$804.31$146.16RVU25C
2025-04-01$804.31$146.16RVU25B
2025-01-01$804.31$146.16RVU25A
2024-10-01$848.05$148.95RVU24D
2024-07-01$848.05$148.95RVU24C
2024-04-01$848.05$148.95RVU24B
2024-03-09$848.05$148.95RVU24AR
2024-01-01$834.21$146.52RVU24A
2023-10-01$895.54$152.03RVU23D
2023-07-01$895.54$152.03RVU23C
2023-04-01$895.54$152.03RVU23B
2023-01-01$895.54$152.03RVU23A
2022-10-01$943.48$153.94RVU22D
2022-07-01$943.48$153.94RVU22C
2022-04-01$943.48$153.94RVU22B
2022-01-01$943.48$153.94RVU22A
2021-10-01$1,008.17$155.35RVU21D
2021-07-01$1,008.17$155.35RVU21C
2021-04-01$1,008.17$155.35RVU21B
2021-01-01$1,008.17$155.35RVU21A
2020-10-01$1,019.23$163.26RVU20D
2020-07-01$1,019.23$163.26RVU20C
2020-04-01$1,019.23$163.26RVU20B
2020-01-01$1,019.23$163.26RVU20A
2019-10-01$1,031.31$163.68RVU19D
2019-07-01$1,031.31$163.68RVU19C
2019-04-01$1,031.31$163.68RVU19B
2019-01-01$1,031.31$163.68RVU19A
2018-10-01$1,051.00$163.90RVU18D
2018-07-01$1,051.00$163.90RVU18C
2018-04-01$1,051.00$163.90RVU18B
2018-01-01$1,051.00$163.90RVU18AR1
2017-10-01$1,050.87$165.33RVU17D
2017-07-01$1,050.87$165.33RVU17C
2017-04-01$1,050.87$165.33RVU17B
2017-01-01$1,050.87$165.33RVU17A
2016-10-01$1,133.59$179.14RVU16D
2016-07-01$1,133.59$179.14RVU16C
2016-04-01$1,133.59$179.14RVU16B
2016-01-01$1,133.59$179.14RVU16A
2015-10-01$1,135.79$181.12RVU15D
2015-07-01$1,135.79$181.12RVU15C
2015-04-01$1,130.13$180.21RVU15B
2015-01-01$1,130.13$180.21RVU15A
2014-10-01$1,124.54$179.86RVU14D
2014-07-01$1,124.54$179.86RVU14C
2014-04-01$1,124.54$179.86RVU14B
2014-01-01$1,124.54$179.86RVU14A
2013-10-01$1,141.97$172.15RVU13D
2013-07-01$1,141.97$172.15RVU13C
2013-04-01$1,141.97$172.15RVU13B
2013-01-01$1,141.97$172.15RVU13AR

Price 49446 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

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
RVUs for 49446PPRRVU2026_Oct_nonQPP.csv, line 5,815 (RVU26D)
Geographic factors for ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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