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CPT code 49450: Feeding tube replacement, gastrostomy or cecostomy2026 Medicare rate & RVUs in Puerto Rico

Report this service when a clinician replaces an existing gastrostomy or cecostomy tube percutaneously using fluoroscopic guidance and contrast assessment.

CMS RVU26DEffective Oct 1, 2026One payment locality20.2K Medicare services in 2024

In Puerto Rico, Medicare pays $569.73 for 49450 in the office and $56.45 when it’s performed in a hospital or facility.

$569.73Office (non-facility)
$56.45Hospital or facility
+1.0%vs the national office rate ($564.14)

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.

We’ll open 49450 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 49450 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 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 Puerto Rico 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. Puerto Rico pays $569.73. The RVUs are the same everywhere; the geographic indexes change the dollars.

49450 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$569.73
  2. Los Angeles, CA · California$658.47+$88.74
  3. Washington, DC area · District of Columbia$658.72+$88.99
  4. Miami, FL · Florida$592.90+$23.17
  5. Chicago, IL · Illinois$573.51+$3.78
  6. Manhattan, NY · New York$653.30+$83.57
  7. Alaska · Alaska$617.56+$47.83

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

Every other payment area

49450 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$497.63$53.40
ArkansasArkansas$489.14$53.03
ArizonaArizona$547.46$55.51
Bakersfield, CACalifornia$612.44$56.01
Chico, CACalifornia$611.98$55.55
El Centro, CACalifornia$612.01$55.58
Fresno, CACalifornia$611.98$55.55
Hanford, CACalifornia$611.98$55.55

49450 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.

$489.14

$703.09

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

View every state and territory as a table
49450 office rate range by state
State / territoryOffice rate rangeLocalities
AK$617.561
AL$497.631
AR$489.141
AZ$547.461
CA$611.98–$794.2029
CO$596.521
CT$605.711
DC$658.721
DE$557.681
FL$544.01–$592.903
GA$509.51–$573.522
GU$632.551
HI$632.551
IA$517.371
ID$520.321
IL$522.18–$582.224
IN$523.991
KS$512.241
KY$506.581
LA$504.74–$534.452
MA$591.11–$665.262
MD$570.35–$658.723
ME$521.07–$557.662
MI$520.01–$549.562
MN$575.541
MO$492.98–$539.453
MS$491.291
MT$564.131
NC$527.851
ND$561.171
NE$521.391
NH$584.621
NJ$613.76–$649.632
NM$522.431
NV$563.821
NY$536.92–$668.565
OH$519.401
OK$507.951
OR$560.59–$620.702
PA$521.66–$587.012
PR$569.731
RI$581.431
SC$524.271
SD$560.811
TN$514.981
TX$517.46–$593.518
UT$532.751
VA$553.92–$658.722
VI$569.731
VT$556.521
WA$590.80–$682.282
WI$539.061
WV$498.871
WY$562.841

See 49450 in every payment locality

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

Office or facility?

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 49450 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.33× 1.0001.3300
Practice expense15.41× 1.01115.5795
Malpractice0.15× 0.9850.1477
Total RVUs17.0573
Conversion factor× 33.4009

Office rate, Puerto Rico$569.73

Office: (1.33 × 1 + 15.41 × 1.011 + 0.15 × 0.985) × $33.4009 = $569.73

Facility: (1.33 × 1 + 0.21 × 1.011 + 0.15 × 0.985) × $33.4009 = $56.45

Open 49450 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 49450

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

Codes related to 49450
CodeHow it relatesOffice range, Puerto Rico
Same family
49451Feeding tube exchange, duodenal or jejunal tubeReplacement of a percutaneous duodenostomy or jejunostomy tube.$607.66
49452G-J tube replacement, percutaneous exchangeReplacement of a percutaneous gastrojejunostomy tube.$734.19
Used instead
49440Gastrostomy placement, percutaneous, image-guidedInitial percutaneous gastrostomy tube placement rather than replacement through an established tract.$795.15
43762G-tube replacement, no tract revisionPercutaneous gastrostomy tube replacement without imaging or endoscopic guidance.$274.81
43763G-tube replacement, with gastrostomy tract revisionGastrostomy tube replacement involving revision of the gastrostomy tract.$375.77
49465Tube examination, fluoroscopic contrast studyFluoroscopic tube assessment when no tube replacement is performed.$131.09

How 49450 has changed in Puerto Rico

49450 · Office / nonfacility

$569.73

Effective 2026-10-01

The base rate is $17.73 higher than on 2025-10-01, moving from $552.00 to $569.73 (3.2%).

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

    $552.00changed to$569.73

    • 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
    • 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

    $586.84changed to$552.00

    • 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.

  3. March 9, 2024

    RVU24AR

    $577.26changed to$586.84

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $618.78changed to$577.26

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

  5. October 1, 2023

    RVU23D

    $614.37changed to$618.78

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

  6. January 1, 2023

    RVU23A

    $646.26changed to$614.37

    • 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
    • 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

    $685.73changed to$646.26

    • 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

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $681.98changed to$685.73

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $681.86changed to$681.98

    • 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
    • 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

    $686.18changed to$681.86

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 17.45 changed to 17.31

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $586.34changed to$686.18

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 17.40 changed to 17.45
    • 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

    $492.55changed to$586.34

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 17.53 changed to 17.40
    • 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

    $492.91changed to$492.55

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 17.47 changed to 17.53
    • Malpractice RVU 0.14 changed to 0.13

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $490.46changed to$492.91

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $482.11changed to$490.46

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 17.44 changed to 17.47
    • Malpractice RVU 0.11 changed to 0.14
    • 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

    $486.49changed to$482.11

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 19.04 changed to 17.44
    • Malpractice RVU 0.12 changed to 0.11
    • 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: $486.49

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$569.73$56.45RVU26D
2026-07-01$569.73$56.45RVU26C
2026-04-01$569.73$56.45RVU26B
2026-01-01$569.73$56.45RVU26A
2025-10-01$552.00$62.75RVU25D
2025-07-01$552.00$62.75RVU25C
2025-04-01$552.00$62.75RVU25B
2025-01-01$552.00$62.75RVU25A
2024-10-01$586.84$63.58RVU24D
2024-07-01$586.84$63.58RVU24C
2024-04-01$586.84$63.58RVU24B
2024-03-09$586.84$63.58RVU24AR
2024-01-01$577.26$62.54RVU24A
2023-10-01$618.78$66.10RVU23D
2023-07-01$614.37$66.08RVU23C
2023-04-01$614.37$66.08RVU23B
2023-01-01$614.37$66.08RVU23A
2022-10-01$646.26$65.46RVU22D
2022-07-01$646.26$65.46RVU22C
2022-04-01$646.26$65.46RVU22B
2022-01-01$646.26$65.46RVU22A
2021-10-01$685.73$66.70RVU21D
2021-07-01$685.73$66.70RVU21C
2021-04-01$685.73$66.70RVU21B
2021-01-01$685.73$66.70RVU21A
2020-10-01$681.98$69.00RVU20D
2020-07-01$681.98$69.00RVU20C
2020-04-01$681.98$69.00RVU20B
2020-01-01$681.98$69.00RVU20A
2019-10-01$681.86$69.26RVU19D
2019-07-01$681.86$69.26RVU19C
2019-04-01$681.86$69.26RVU19B
2019-01-01$681.86$69.26RVU19A
2018-10-01$686.18$69.54RVU18D
2018-07-01$686.18$69.54RVU18C
2018-04-01$686.18$69.54RVU18B
2018-01-01$686.18$69.54RVU18AR1
2017-10-01$586.34$65.63RVU17D
2017-07-01$586.34$65.63RVU17C
2017-04-01$586.34$65.63RVU17B
2017-01-01$586.34$65.63RVU17A
2016-10-01$492.55$61.67RVU16D
2016-07-01$492.55$61.67RVU16C
2016-04-01$492.55$61.67RVU16B
2016-01-01$492.55$61.67RVU16A
2015-10-01$492.91$62.00RVU15D
2015-07-01$492.91$62.00RVU15C
2015-04-01$490.46$61.69RVU15B
2015-01-01$490.46$61.69RVU15A
2014-10-01$482.11$61.44RVU14D
2014-07-01$482.11$61.44RVU14C
2014-04-01$482.11$61.44RVU14B
2014-01-01$482.11$61.44RVU14A
2013-10-01$486.49$58.36RVU13D
2013-07-01$486.49$58.36RVU13C
2013-04-01$486.49$58.36RVU13B
2013-01-01$486.49$58.36RVU13AR

Price 49450 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

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
RVUs for 49450PPRRVU2026_Oct_nonQPP.csv, line 5,816 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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