CPT code 49450: Feeding tube replacement, gastrostomy or cecostomy2026 Medicare rate & RVUs in El Centro, CA
Report this service when a clinician replaces an existing gastrostomy or cecostomy tube percutaneously using fluoroscopic guidance and contrast assessment.
In El Centro, CA, Medicare pays $612.01 for 49450 in the office and $55.58 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 49450 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 49450 covers
This service covers percutaneous replacement of an existing gastrostomy or cecostomy tube, with fluoroscopic guidance and contrast assessment to confirm tube position and function. It is commonly performed by an interventional radiologist in an imaging suite when a tube is dislodged, malfunctioning, or due for exchange. It is a replacement through an established tract, not creation of a new gastrostomy or cecostomy tract.
Report the code when documentation supports replacement of the existing tube and the imaging work associated with the exchange. The 0-day global includes same-day preoperative and postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. 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 El Centro, CA compares for 49450
Across 109 of 109 payment localities, the office rate for 49450 runs from $489.14 in Arkansas to $794.20 in San Benito County, CA. El Centro, CA pays $612.01. The RVUs are the same everywhere; the geographic indexes change the dollars.
- El Centro, CA · this page$612.01
- Bakersfield, CA · California$612.44+$0.43
- Chico, CA · California$611.98−$0.03
- Fresno, CA · California$611.98−$0.03
- Hanford, CA · California$611.98−$0.03
- Los Angeles, CA · California$658.47+$46.46
- Madera, CA · California$611.98−$0.03
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Merced, CACalifornia | $611.98 | $55.55 |
| Modesto, CACalifornia | $611.98 | $55.55 |
| Napa, CACalifornia | $728.15 | $59.01 |
| Oxnard, CACalifornia | $657.17 | $57.08 |
| Redding, CACalifornia | $611.98 | $55.55 |
| Rest of CaliforniaCalifornia | $611.98 | $55.55 |
| Riverside, CACalifornia | $613.62 | $57.18 |
| Sacramento, CACalifornia | $647.31 | $56.87 |
| Salinas, CACalifornia | $645.03 | $56.62 |
| San Diego, CACalifornia | $664.06 | $56.86 |
| Marin County, CACalifornia | $776.68 | $60.83 |
| San Francisco, CACalifornia | $776.51 | $60.66 |
| San Benito County, CACalifornia | $794.20 | $62.11 |
| Santa Clara County, CACalifornia | $793.51 | $61.41 |
| San Luis Obispo, CACalifornia | $634.12 | $55.85 |
| Santa Cruz, CACalifornia | $673.41 | $56.56 |
| Santa Maria, CACalifornia | $648.50 | $56.53 |
| Santa Rosa, CACalifornia | $680.50 | $57.05 |
| Stockton, CACalifornia | $611.98 | $55.55 |
| Vallejo, CACalifornia | $727.91 | $58.77 |
| Visalia, CACalifornia | $611.98 | $55.55 |
| Yuba City, CACalifornia | $611.98 | $55.55 |
| Washington, DC areaDistrict of Columbia | $658.72 | $60.66 |
| Miami, FLFlorida | $592.90 | $64.40 |
| Chicago, ILIllinois | $573.51 | $63.28 |
| Manhattan, NYNew York | $653.30 | $63.36 |
| AlaskaAlaska | $617.56 | $76.87 |
| AlabamaAlabama | $497.63 | $53.40 |
| ArkansasArkansas | $489.14 | $53.03 |
| ArizonaArizona | $547.46 | $55.51 |
| ColoradoColorado | $596.52 | $56.33 |
| ConnecticutConnecticut | $605.71 | $58.93 |
| DelawareDelaware | $557.68 | $56.08 |
| Fort Lauderdale, FLFlorida | $574.88 | $60.59 |
| Rest of FloridaFlorida | $544.01 | $58.66 |
| Atlanta, GAGeorgia | $573.52 | $57.70 |
| Rest of GeorgiaGeorgia | $509.51 | $56.65 |
| Hawaii, Guam, HIHawaii | $632.55 | $55.30 |
| IowaIowa | $517.37 | $52.83 |
| IdahoIdaho | $520.32 | $53.25 |
| East St. Louis, ILIllinois | $528.04 | $60.97 |
| Rest of IllinoisIllinois | $522.18 | $58.66 |
| Suburban Chicago, ILIllinois | $582.22 | $60.82 |
| IndianaIndiana | $523.99 | $53.36 |
| KansasKansas | $512.24 | $53.29 |
| KentuckyKentucky | $506.58 | $55.24 |
| New Orleans, LALouisiana | $534.45 | $56.72 |
| Rest of LouisianaLouisiana | $504.74 | $55.43 |
| Metropolitan Boston, MAMassachusetts | $665.26 | $59.08 |
| Rest of MassachusettsMassachusetts | $591.11 | $56.51 |
| Baltimore area, MDMaryland | $603.61 | $58.86 |
| Rest of MarylandMaryland | $570.35 | $56.57 |
| Rest of MaineMaine | $521.07 | $53.99 |
| Southern Maine, MEMaine | $557.66 | $54.54 |
| Detroit, MIMichigan | $549.56 | $59.64 |
| Rest of MichiganMichigan | $520.01 | $56.48 |
| MinnesotaMinnesota | $575.54 | $53.12 |
| Metropolitan Kansas City, MOMissouri | $532.63 | $55.90 |
| Metropolitan St. Louis, MOMissouri | $539.45 | $56.12 |
| Rest of MissouriMissouri | $492.98 | $55.35 |
| MississippiMississippi | $491.29 | $54.16 |
| MontanaMontana | $564.13 | $56.44 |
| North CarolinaNorth Carolina | $527.85 | $54.17 |
| North DakotaNorth Dakota | $561.17 | $53.47 |
| NebraskaNebraska | $521.39 | $52.79 |
| New HampshireNew Hampshire | $584.62 | $56.11 |
| Northern New JerseyNew Jersey | $649.63 | $60.71 |
| Rest of New JerseyNew Jersey | $613.76 | $59.36 |
| New MexicoNew Mexico | $522.43 | $56.87 |
| NevadaNevada | $563.82 | $55.62 |
| NYC suburbs and Long Island, NYNew York | $668.56 | $64.91 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $616.09 | $60.17 |
| Queens, NYNew York | $662.88 | $62.78 |
| Rest of New YorkNew York | $536.92 | $54.61 |
| OhioOhio | $519.40 | $55.88 |
| OklahomaOklahoma | $507.95 | $54.58 |
| Portland, OROregon | $620.70 | $56.65 |
| Rest of OregonOregon | $560.59 | $54.93 |
| Metropolitan Philadelphia, PAPennsylvania | $587.01 | $58.50 |
| Rest of PennsylvaniaPennsylvania | $521.66 | $55.60 |
| Puerto RicoPuerto Rico | $569.73 | $56.45 |
| Rhode IslandRhode Island | $581.43 | $56.98 |
| South CarolinaSouth Carolina | $524.27 | $55.16 |
| South DakotaSouth Dakota | $560.81 | $53.12 |
| TennesseeTennessee | $514.98 | $53.49 |
| Austin, TXTexas | $593.51 | $56.37 |
| Beaumont, TXTexas | $517.46 | $55.46 |
| Brazoria, TXTexas | $558.76 | $55.64 |
| Dallas, TXTexas | $561.77 | $56.11 |
| Fort Worth, TXTexas | $556.69 | $56.10 |
| Galveston, TXTexas | $560.03 | $55.89 |
| Houston, TXTexas | $562.78 | $58.64 |
| Rest of TexasTexas | $537.41 | $55.60 |
| UtahUtah | $532.75 | $55.52 |
| VirginiaVirginia | $553.92 | $54.86 |
| Virgin Islands, VIUnited States Virgin Islands | $569.73 | $56.45 |
| VermontVermont | $556.52 | $53.90 |
| Rest of WashingtonWashington | $590.80 | $56.20 |
| King County, WAWashington | $682.28 | $59.34 |
| WisconsinWisconsin | $539.06 | $52.69 |
| West VirginiaWest Virginia | $498.87 | $57.69 |
| WyomingWyoming | $562.84 | $55.14 |
49450 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.
$489.14
$703.09
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 | $617.56 | 1 |
| AL | $497.63 | 1 |
| AR | $489.14 | 1 |
| AZ | $547.46 | 1 |
| CA | $611.98–$794.20 | 29 |
| CO | $596.52 | 1 |
| CT | $605.71 | 1 |
| DC | $658.72 | 1 |
| DE | $557.68 | 1 |
| FL | $544.01–$592.90 | 3 |
| GA | $509.51–$573.52 | 2 |
| GU | $632.55 | 1 |
| HI | $632.55 | 1 |
| IA | $517.37 | 1 |
| ID | $520.32 | 1 |
| IL | $522.18–$582.22 | 4 |
| IN | $523.99 | 1 |
| KS | $512.24 | 1 |
| KY | $506.58 | 1 |
| LA | $504.74–$534.45 | 2 |
| MA | $591.11–$665.26 | 2 |
| MD | $570.35–$658.72 | 3 |
| ME | $521.07–$557.66 | 2 |
| MI | $520.01–$549.56 | 2 |
| MN | $575.54 | 1 |
| MO | $492.98–$539.45 | 3 |
| MS | $491.29 | 1 |
| MT | $564.13 | 1 |
| NC | $527.85 | 1 |
| ND | $561.17 | 1 |
| NE | $521.39 | 1 |
| NH | $584.62 | 1 |
| NJ | $613.76–$649.63 | 2 |
| NM | $522.43 | 1 |
| NV | $563.82 | 1 |
| NY | $536.92–$668.56 | 5 |
| OH | $519.40 | 1 |
| OK | $507.95 | 1 |
| OR | $560.59–$620.70 | 2 |
| PA | $521.66–$587.01 | 2 |
| PR | $569.73 | 1 |
| RI | $581.43 | 1 |
| SC | $524.27 | 1 |
| SD | $560.81 | 1 |
| TN | $514.98 | 1 |
| TX | $517.46–$593.51 | 8 |
| UT | $532.75 | 1 |
| VA | $553.92–$658.72 | 2 |
| VI | $569.73 | 1 |
| VT | $556.52 | 1 |
| WA | $590.80–$682.28 | 2 |
| WI | $539.06 | 1 |
| WV | $498.87 | 1 |
| WY | $562.84 | 1 |
How the 49450 rate is calculated
Each of 49450’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 · 49450
RVUs × geographic indexes × conversion factor
Work1.33
1.33 RVUs× 1.000 GPCI
Practice expense15.41
15.41 RVUs× 1.000 GPCI
Malpractice0.15
0.15 RVUs× 1.000 GPCI
Adjusted RVUs
16.8900
Conversion factor
$33.4009
Medicare rate
$564.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact El Centro, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,816
- Code
- 49450
- Physician work
- 1.33
- Practice expense
- 15.41
- Malpractice
- 0.15
GPCI2026.csv
10
- Locality
- El Centro, CA
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.541
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.33 | × 1.017 | 1.3526 |
| Practice expense | 15.41 | × 1.096 | 16.8894 |
| Malpractice | 0.15 | × 0.541 | 0.0811 |
| Total RVUs | 18.3231 | ||
| Conversion factor | × 33.4009 | ||
Office rate, El Centro, CA$612.01
Office: (1.33 × 1.017 + 15.41 × 1.096 + 0.15 × 0.541) × $33.4009 = $612.01
Facility: (1.33 × 1.017 + 0.21 × 1.096 + 0.15 × 0.541) × $33.4009 = $55.58
Payment rules and modifiers for 49450
The CMS indicators that decide how 49450 is paid alongside other services.
CMS payment indicators · 49450
Feeding tube replacement, gastrostomy or cecostomy
| 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
49450 without 51 · national office
$564.14
Feeding tube replacement, gastrostomy or cecostomy
49450-51 · Second procedure: 50%
$282.07
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 49450 has changed in El Centro, CA
49450 · Office / nonfacility
$612.01
Effective 2026-10-01
The base rate is $18.58 higher than on 2025-10-01, moving from $593.43 to $612.01 (3.1%).
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
$593.43changed to$612.01
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.36 changed to 1.33
- Practice expense RVU 15.44 changed to 15.41
- Malpractice RVU 0.16 changed to 0.15
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.570 changed to 0.541
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$631.25changed to$593.43
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 16.01 changed to 15.44
- Malpractice RVU 0.15 changed to 0.16
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$620.94changed to$631.25
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$657.45changed to$620.94
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 16.60 changed to 16.01
- Malpractice RVU 0.17 changed to 0.15
- Work GPCI 1.021 changed to 1.014
- Practice expense GPCI 1.079 changed to 1.093
- Malpractice GPCI 0.595 changed to 0.570
January 1, 2023
RVU23A
$679.67changed to$657.45
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 17.06 changed to 16.60
- Malpractice RVU 0.12 changed to 0.17
- Work GPCI 1.027 changed to 1.021
- Practice expense GPCI 1.065 changed to 1.079
- Malpractice GPCI 0.620 changed to 0.595
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$721.17changed to$679.67
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 18.02 changed to 17.06
- Malpractice RVU 0.13 changed to 0.12
- Malpractice GPCI 0.616 changed to 0.620
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$720.17changed to$721.17
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 17.28 changed to 18.02
- Malpractice RVU 0.12 changed to 0.13
- Work GPCI 1.024 changed to 1.027
- Practice expense GPCI 1.070 changed to 1.065
- Malpractice GPCI 0.606 changed to 0.616
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$722.66changed to$720.17
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 17.31 changed to 17.28
- Malpractice RVU 0.13 changed to 0.12
- Work GPCI 1.020 changed to 1.024
- Practice expense GPCI 1.074 changed to 1.070
- Malpractice GPCI 0.570 changed to 0.606
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$727.27changed to$722.66
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 17.45 changed to 17.31
- Malpractice GPCI 0.567 changed to 0.570
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$726.62changed to$727.27
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 17.40 changed to 17.45
- Work GPCI 1.024 changed to 1.020
- Practice expense GPCI 1.079 changed to 1.074
- Malpractice GPCI 0.610 changed to 0.567
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$726.62
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 | $612.01 | $55.58 | RVU26D |
| 2026-07-01 | $612.01 | $55.58 | RVU26C |
| 2026-04-01 | $612.01 | $55.58 | RVU26B |
| 2026-01-01 | $612.01 | $55.58 | RVU26A |
| 2025-10-01 | $593.43 | $62.41 | RVU25D |
| 2025-07-01 | $593.43 | $62.41 | RVU25C |
| 2025-04-01 | $593.43 | $62.41 | RVU25B |
| 2025-01-01 | $593.43 | $62.41 | RVU25A |
| 2024-10-01 | $631.25 | $63.30 | RVU24D |
| 2024-07-01 | $631.25 | $63.30 | RVU24C |
| 2024-04-01 | $631.25 | $63.30 | RVU24B |
| 2024-03-09 | $631.25 | $63.30 | RVU24AR |
| 2024-01-01 | $620.94 | $62.27 | RVU24A |
| 2023-10-01 | $657.45 | $65.84 | RVU23D |
| 2023-07-01 | $657.45 | $65.84 | RVU23C |
| 2023-04-01 | $657.45 | $65.84 | RVU23B |
| 2023-01-01 | $657.45 | $65.84 | RVU23A |
| 2022-10-01 | $679.67 | $66.02 | RVU22D |
| 2022-07-01 | $679.67 | $66.02 | RVU22C |
| 2022-04-01 | $679.67 | $66.02 | RVU22B |
| 2022-01-01 | $679.67 | $66.02 | RVU22A |
| 2021-10-01 | $721.17 | $67.14 | RVU21D |
| 2021-07-01 | $721.17 | $67.14 | RVU21C |
| 2021-04-01 | $721.17 | $67.14 | RVU21B |
| 2021-01-01 | $721.17 | $67.14 | RVU21A |
| 2020-10-01 | $720.17 | $69.49 | RVU20D |
| 2020-07-01 | $720.17 | $69.49 | RVU20C |
| 2020-04-01 | $720.17 | $69.49 | RVU20B |
| 2020-01-01 | $720.17 | $69.49 | RVU20A |
| 2019-10-01 | $722.66 | $69.31 | RVU19D |
| 2019-07-01 | $722.66 | $69.31 | RVU19C |
| 2019-04-01 | $722.66 | $69.31 | RVU19B |
| 2019-01-01 | $722.66 | $69.31 | RVU19A |
| 2018-10-01 | $727.27 | $69.60 | RVU18D |
| 2018-07-01 | $727.27 | $69.60 | RVU18C |
| 2018-04-01 | $727.27 | $69.60 | RVU18B |
| 2018-01-01 | $727.27 | $69.60 | RVU18AR1 |
| 2017-10-01 | $726.62 | $70.25 | RVU17D |
| 2017-07-01 | $726.62 | $70.25 | RVU17C |
| 2017-04-01 | $726.62 | $70.25 | RVU17B |
| 2017-01-01 | $726.62 | $70.25 | 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 El Centro, CA rate applies
El Centro, CA is a Medicare payment area, not a city. Our Census mapping connects it to 18 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- El Centro
- Bombay Beach
- Brawley
- Calexico
- Calipatria
- Desert Shores
- El Centro Naval Air Facility
- Heber
49450 billing questions
How does this differ from 49451 or 49452?
49450 is for replacing a gastrostomy or cecostomy tube. Use 49451 for a duodenostomy or jejunostomy tube and 49452 for a gastrojejunostomy tube.
Can the fluoroscopic tube check be reported separately?
Fluoroscopic guidance, contrast assessment, and related image documentation for the replacement are included in 49450. Do not separately report a tube check for that same work.
When is 49450 preferable to 43762?
49450 describes replacement with fluoroscopic guidance. 43762 is for percutaneous gastrostomy tube replacement without imaging or endoscopic guidance.
Does 49450 have a global period?
It has a 0-day global period, so same-day preoperative and postoperative care is included.
Can modifier 50 be used for two tubes?
No. CMS identifies bilateral adjustment as inappropriate for this code. Report the service based on the documented procedure and applicable claim rules.
What documentation supports reporting 49450?
Document the existing gastrostomy or cecostomy tube, the replacement performed, and the imaging and contrast assessment supporting the exchange.
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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