CPT code 49451: Feeding tube exchange, duodenal or jejunal tube2026 Medicare rate & RVUs
Report this service when a clinician exchanges an existing percutaneous duodenal or jejunal feeding tube under fluoroscopic guidance and confirms its position.
Medicare pays $601.88 for 49451 nationally in the office and $76.15 in a hospital or facility. Local office rates run $523.04–$841.71.
Medicare rate · 49451
Feeding tube exchange, duodenal or jejunal tube
- Work RVUs
- 1.79
- Total RVUs
- 18.02
- Global days
- 000
National rate · 2026
$601.88
Office setting, before claim adjustments.
See every locality for 49451 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 49451 covers
Code 49451 describes exchanging a duodenostomy or jejunostomy tube through an established percutaneous tract. Fluoroscopy and contrast injections are used to guide the exchange and check tube position; radiological supervision and interpretation are part of the service. Interventional radiologists commonly perform the procedure in hospital or outpatient imaging settings when a tube is malfunctioning, displaced, or due for exchange. This is for an existing access tract, not creation of a new one.
Report the code when the documentation identifies the tube and tract exchanged and supports image-guided replacement. The fluoroscopy, contrast injections, and their interpretation are included in the code. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. If multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this tube exchange. An assistant is payable only when medical necessity is documented; 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.
Where 49451 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$523.04 to $841.71
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $531.95 | $71.94 |
| Alaska | $663.41 | $103.51 |
| Arizona | $584.29 | $74.85 |
| Arkansas | $523.04 | $71.43 |
| Atlanta, GA | $612.03 | $77.89 |
| Austin, TX | $632.24 | $76.02 |
| Bakersfield, CA | $651.65 | $75.45 |
| Baltimore area, MD | $643.56 | $79.46 |
| Beaumont, TX | $553.23 | $74.81 |
| Brazoria, TX | $596.00 | $75.01 |
| Chicago, IL | $614.06 | $85.70 |
| Chico, CA | $651.01 | $74.81 |
| Colorado | $635.31 | $75.93 |
| Connecticut | $645.75 | $79.54 |
| Dallas, TX | $599.29 | $75.66 |
| Delaware | $595.05 | $75.63 |
| Detroit, MI | $587.97 | $80.64 |
| East St. Louis, IL | $566.19 | $82.52 |
| El Centro, CA | $651.05 | $74.85 |
| Fort Lauderdale, FL | $614.51 | $81.94 |
| Fort Worth, TX | $594.03 | $75.66 |
| Fresno, CA | $651.01 | $74.81 |
| Galveston, TX | $597.41 | $75.36 |
| Hanford, CA | $651.01 | $74.81 |
| Hawaii, Guam, HI | $672.24 | $74.48 |
| Houston, TX | $601.25 | $79.20 |
| Idaho | $555.38 | $71.71 |
| Indiana | $559.22 | $71.87 |
| Iowa | $552.17 | $71.13 |
| Kansas | $547.04 | $71.78 |
| Kentucky | $541.89 | $74.52 |
| King County, WA | $725.05 | $79.98 |
| Los Angeles, CA | $699.90 | $77.96 |
| Madera, CA | $651.01 | $74.81 |
| Manhattan, NY | $696.50 | $85.61 |
| Marin County, CA | $823.15 | $81.87 |
| Merced, CA | $651.01 | $74.81 |
| Metropolitan Boston, MA | $707.37 | $79.65 |
| Metropolitan Kansas City, MO | $569.08 | $75.42 |
| Metropolitan Philadelphia, PA | $626.25 | $78.97 |
| Metropolitan St. Louis, MO | $576.21 | $75.72 |
| Miami, FL | $634.55 | $87.26 |
| Minnesota | $612.46 | $71.49 |
| Mississippi | $525.68 | $73.02 |
| Modesto, CA | $651.01 | $74.81 |
| Montana | $601.87 | $76.14 |
| Napa, CA | $772.36 | $79.44 |
| Nebraska | $556.32 | $71.07 |
| Nevada | $601.25 | $74.99 |
| New Hampshire | $622.95 | $75.66 |
| New Mexico | $558.88 | $76.79 |
| New Orleans, LA | $571.27 | $76.56 |
| North Carolina | $563.50 | $73.00 |
| North Dakota | $597.72 | $71.99 |
| Northern New Jersey | $691.74 | $81.89 |
| NYC suburbs and Long Island, NY | $712.85 | $87.76 |
| Ohio | $555.39 | $75.40 |
| Oklahoma | $543.07 | $73.59 |
| Oxnard, CA | $698.30 | $76.89 |
| Portland, OR | $660.44 | $76.35 |
| Poughkeepsie and northern NYC suburbs, NY | $656.88 | $81.21 |
| Puerto Rico | $607.66 | $76.15 |
| Queens, NY | $706.20 | $84.78 |
| Redding, CA | $651.01 | $74.81 |
| Rest of California | $651.01 | $74.81 |
| Rest of Florida | $581.87 | $79.27 |
| Rest of Georgia | $545.44 | $76.49 |
| Rest of Illinois | $559.28 | $79.29 |
| Rest of Louisiana | $540.06 | $74.78 |
| Rest of Maine | $556.43 | $72.75 |
| Rest of Maryland | $608.33 | $76.29 |
| Rest of Massachusetts | $629.78 | $76.18 |
| Rest of Michigan | $556.24 | $76.25 |
| Rest of Missouri | $527.86 | $74.68 |
| Rest of New Jersey | $654.18 | $80.09 |
| Rest of New York | $573.05 | $73.60 |
| Rest of Oregon | $597.66 | $74.03 |
| Rest of Pennsylvania | $557.62 | $75.00 |
| Rest of Texas | $573.91 | $75.00 |
| Rest of Washington | $629.34 | $75.75 |
| Rhode Island | $619.92 | $76.84 |
| Riverside, CA | $653.30 | $77.10 |
| Sacramento, CA | $688.00 | $76.58 |
| Salinas, CA | $685.56 | $76.24 |
| San Benito County, CA | $841.71 | $83.61 |
| San Diego, CA | $705.34 | $76.57 |
| San Francisco, CA | $822.91 | $81.64 |
| San Luis Obispo, CA | $674.02 | $75.22 |
| Santa Clara County, CA | $840.74 | $82.63 |
| Santa Cruz, CA | $714.93 | $76.17 |
| Santa Maria, CA | $689.13 | $76.13 |
| Santa Rosa, CA | $722.42 | $76.83 |
| South Carolina | $560.17 | $74.39 |
| South Dakota | $597.23 | $71.50 |
| Southern Maine, ME | $594.48 | $73.48 |
| Stockton, CA | $651.01 | $74.81 |
| Suburban Chicago, IL | $622.16 | $82.24 |
| Tennessee | $549.94 | $72.06 |
| Utah | $569.06 | $74.88 |
| Vallejo, CA | $772.01 | $79.10 |
| Vermont | $593.07 | $72.60 |
| Virgin Islands, VI | $607.66 | $76.15 |
| Virginia | $590.73 | $73.93 |
| Visalia, CA | $651.01 | $74.81 |
| Washington, DC area | $701.15 | $81.84 |
| West Virginia | $534.81 | $77.95 |
| Wisconsin | $574.56 | $70.91 |
| Wyoming | $600.06 | $74.33 |
| Yuba City, CA | $651.01 | $74.81 |
49451 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.
$523.04
$746.36
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 | $663.41 | 1 |
| AL | $531.95 | 1 |
| AR | $523.04 | 1 |
| AZ | $584.29 | 1 |
| CA | $651.01–$841.71 | 29 |
| CO | $635.31 | 1 |
| CT | $645.75 | 1 |
| DC | $701.15 | 1 |
| DE | $595.05 | 1 |
| FL | $581.87–$634.55 | 3 |
| GA | $545.44–$612.03 | 2 |
| GU | $672.24 | 1 |
| HI | $672.24 | 1 |
| IA | $552.17 | 1 |
| ID | $555.38 | 1 |
| IL | $559.28–$622.16 | 4 |
| IN | $559.22 | 1 |
| KS | $547.04 | 1 |
| KY | $541.89 | 1 |
| LA | $540.06–$571.27 | 2 |
| MA | $629.78–$707.37 | 2 |
| MD | $608.33–$701.15 | 3 |
| ME | $556.43–$594.48 | 2 |
| MI | $556.24–$587.97 | 2 |
| MN | $612.46 | 1 |
| MO | $527.86–$576.21 | 3 |
| MS | $525.68 | 1 |
| MT | $601.87 | 1 |
| NC | $563.50 | 1 |
| ND | $597.72 | 1 |
| NE | $556.32 | 1 |
| NH | $622.95 | 1 |
| NJ | $654.18–$691.74 | 2 |
| NM | $558.88 | 1 |
| NV | $601.25 | 1 |
| NY | $573.05–$712.85 | 5 |
| OH | $555.39 | 1 |
| OK | $543.07 | 1 |
| OR | $597.66–$660.44 | 2 |
| PA | $557.62–$626.25 | 2 |
| PR | $607.66 | 1 |
| RI | $619.92 | 1 |
| SC | $560.17 | 1 |
| SD | $597.23 | 1 |
| TN | $549.94 | 1 |
| TX | $553.23–$632.24 | 8 |
| UT | $569.06 | 1 |
| VA | $590.73–$701.15 | 2 |
| VI | $607.66 | 1 |
| VT | $593.07 | 1 |
| WA | $629.34–$725.05 | 2 |
| WI | $574.56 | 1 |
| WV | $534.81 | 1 |
| WY | $600.06 | 1 |
How the 49451 rate is calculated
Each of 49451’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 · 49451
RVUs × geographic indexes × conversion factor
Work1.79
1.79 RVUs× 1.000 GPCI
Practice expense16.02
16.02 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
18.0200
Conversion factor
$33.4009
Medicare rate
$601.88
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49451
The CMS indicators that decide how 49451 is paid alongside other services.
CMS payment indicators · 49451
Feeding tube exchange, duodenal or jejunal 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
49451 without 51 · national office
$601.88
Feeding tube exchange, duodenal or jejunal tube
49451-51 · Second procedure: 50%
$300.94
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%).
49451 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49441Enteral tube placementDuodenal or jejunal tube
- Choose 49441 for percutaneous placement of a duodenal or jejunal tube. Choose 49451 when replacing an existing tube through its established access tract.
- 49450Feeding tube replacementGastrostomy or cecostomy
- 49450 covers percutaneous replacement of a gastrostomy or cecostomy tube; 49451 is for a duodenostomy or jejunostomy tube.
- 49452G-J tube replacementPercutaneous exchange
- 49452 is for replacement of a gastrojejunal tube, which has gastric and jejunal portions. 49451 is for a duodenostomy or jejunostomy tube.
49451 billing questions
How is 49451 different from 49441?
49451 is for exchanging an existing duodenostomy or jejunostomy tube through its established tract. 49441 describes percutaneous placement of a duodenal or jejunal tube, rather than replacement.
Can fluoroscopy or contrast be billed separately?
No. Fluoroscopic guidance, contrast injections, and radiological supervision and interpretation are included in 49451 for the tube exchange.
When is modifier 50 appropriate?
Modifier 50 is inappropriate for 49451; the service concerns an individual tube and is not a bilateral procedure.
What documentation supports reporting 49451?
Document the existing duodenostomy or jejunostomy access, the exchange performed, and the image-guided confirmation of the replacement tube's position.
How does the multiple-procedure reduction affect this code?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
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
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