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

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 Delaware, Medicare pays $755.03 for 49446 in the office and $125.39 when it’s performed in a hospital or facility.

$755.03Office (non-facility)
$125.39Hospital or facility
−1.1%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 Delaware
  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 Delaware 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. Delaware pays $755.03. The RVUs are the same everywhere; the geographic indexes change the dollars.

49446 in Delaware vs other payment areas
  1. Delaware · this page$755.03
  2. Los Angeles, CA · California$883.07+$128.04
  3. Washington, DC area · District of Columbia$886.35+$131.32
  4. Miami, FL · Florida$808.16+$53.13
  5. Chicago, IL · Illinois$782.64+$27.61
  6. Manhattan, NY · New York$882.44+$127.41
  7. Alaska · Alaska$850.46+$95.43

Other areas in Delaware 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 Delaware 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

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 49446 in Delaware
ComponentRVULocality factorAdjusted
Physician work2.98× 1.0052.9949
Practice expense19.53× 0.98819.2956
Malpractice0.35× 0.8990.3146
Total RVUs22.6052
Conversion factor× 33.4009

Office rate, Delaware$755.03

Office: (2.98 × 1.005 + 19.53 × 0.988 + 0.35 × 0.899) × $33.4009 = $755.03

Facility: (2.98 × 1.005 + 0.45 × 0.988 + 0.35 × 0.899) × $33.4009 = $125.39

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, Delaware
Used instead
49452G-J tube replacement, percutaneous exchangeUsed to replace an existing G-J tube rather than convert a gastrostomy to G-J access.$719.43
49450Feeding tube replacement, gastrostomy or cecostomyUsed when replacing a gastrostomy tube while retaining gastric access.$557.68
49440Gastrostomy placement, percutaneous, image-guidedReports percutaneous placement of gastrostomy access rather than conversion of an existing tract.$779.70
49441Enteral tube placement, duodenal or jejunal tubeReports percutaneous placement of duodenal or jejunal access rather than conversion through a gastrostomy.$970.27

How 49446 has changed in Delaware

49446 · Office / nonfacility

$755.03

Effective 2026-10-01

The base rate is $17.39 higher than on 2025-10-01, moving from $737.64 to $755.03 (2.4%).

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

    $737.64changed to$755.03

    • 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 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $777.59changed to$737.64

    • 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

    $764.90changed to$777.59

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $824.74changed to$764.90

    • 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 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $871.92changed to$824.74

    • 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 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $931.28changed to$871.92

    • 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

    $942.03changed to$931.28

    • 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 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $952.63changed to$942.03

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 22.62 changed to 22.28
    • Work GPCI 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $970.66changed to$952.63

    • 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

    $971.74changed to$970.66

    • 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 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1050.36changed to$971.74

    • 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 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1052.36changed to$1050.36

    • 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

    $1047.12changed to$1052.36

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1050.11changed to$1047.12

    • 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 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $1074.41changed to$1050.11

    • 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 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $1074.41

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$755.03$125.39RVU26D
2026-07-01$755.03$125.39RVU26C
2026-04-01$755.03$125.39RVU26B
2026-01-01$755.03$125.39RVU26A
2025-10-01$737.64$139.20RVU25D
2025-07-01$737.64$139.20RVU25C
2025-04-01$737.64$139.20RVU25B
2025-01-01$737.64$139.20RVU25A
2024-10-01$777.59$141.93RVU24D
2024-07-01$777.59$141.93RVU24C
2024-04-01$777.59$141.93RVU24B
2024-03-09$777.59$141.93RVU24AR
2024-01-01$764.90$139.61RVU24A
2023-10-01$824.74$145.33RVU23D
2023-07-01$824.74$145.33RVU23C
2023-04-01$824.74$145.33RVU23B
2023-01-01$824.74$145.33RVU23A
2022-10-01$871.92$147.59RVU22D
2022-07-01$871.92$147.59RVU22C
2022-04-01$871.92$147.59RVU22B
2022-01-01$871.92$147.59RVU22A
2021-10-01$931.28$148.88RVU21D
2021-07-01$931.28$148.88RVU21C
2021-04-01$931.28$148.88RVU21B
2021-01-01$931.28$148.88RVU21A
2020-10-01$942.03$156.81RVU20D
2020-07-01$942.03$156.81RVU20C
2020-04-01$942.03$156.81RVU20B
2020-01-01$942.03$156.81RVU20A
2019-10-01$952.63$157.56RVU19D
2019-07-01$952.63$157.56RVU19C
2019-04-01$952.63$157.56RVU19B
2019-01-01$952.63$157.56RVU19A
2018-10-01$970.66$157.76RVU18D
2018-07-01$970.66$157.76RVU18C
2018-04-01$970.66$157.76RVU18B
2018-01-01$970.66$157.76RVU18AR1
2017-10-01$971.74$159.14RVU17D
2017-07-01$971.74$159.14RVU17C
2017-04-01$971.74$159.14RVU17B
2017-01-01$971.74$159.14RVU17A
2016-10-01$1,050.36$172.54RVU16D
2016-07-01$1,050.36$172.54RVU16C
2016-04-01$1,050.36$172.54RVU16B
2016-01-01$1,050.36$172.54RVU16A
2015-10-01$1,052.36$174.33RVU15D
2015-07-01$1,052.36$174.33RVU15C
2015-04-01$1,047.12$173.46RVU15B
2015-01-01$1,047.12$173.46RVU15A
2014-10-01$1,050.11$171.45RVU14D
2014-07-01$1,050.11$171.45RVU14C
2014-04-01$1,050.11$171.45RVU14B
2014-01-01$1,050.11$171.45RVU14A
2013-10-01$1,074.41$162.26RVU13D
2013-07-01$1,074.41$162.26RVU13C
2013-04-01$1,074.41$162.26RVU13B
2013-01-01$1,074.41$162.26RVU13AR

Price 49446 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

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 DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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