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CPT code 49451: Feeding tube exchange, duodenal or jejunal tube2026 Medicare rate & RVUs in San Francisco, CA

Report this service when a clinician exchanges an existing percutaneous duodenal or jejunal feeding tube under fluoroscopic guidance and confirms its position.

CMS RVU26DEffective Oct 1, 2026One payment locality4.6K Medicare services in 2024

In San Francisco, CA, Medicare pays $822.91 for 49451 in the office and $81.64 when it’s performed in a hospital or facility.

$822.91Office (non-facility)
$81.64Hospital or facility
+36.7%vs the national office rate ($601.88)

Check a contract rate as a % of Medicare · 49451 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 49451 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in San Francisco, CA
  2. What 49451 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 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.

How San Francisco, CA compares for 49451

Across 109 of 109 payment localities, the office rate for 49451 runs from $523.04 in Arkansas to $841.71 in San Benito County, CA. San Francisco, CA pays $822.91. The RVUs are the same everywhere; the geographic indexes change the dollars.

49451 in San Francisco, CA vs other payment areas
  1. San Francisco, CA · this page$822.91
  2. Bakersfield, CA · California$651.65−$171.26
  3. Chico, CA · California$651.01−$171.90
  4. El Centro, CA · California$651.05−$171.86
  5. Fresno, CA · California$651.01−$171.90
  6. Hanford, CA · California$651.01−$171.90
  7. Los Angeles, CA · California$699.90−$123.01

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

Every other payment area

49451 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia$651.01$74.81
Merced, CACalifornia$651.01$74.81
Modesto, CACalifornia$651.01$74.81
Napa, CACalifornia$772.36$79.44
Oxnard, CACalifornia$698.30$76.89
Redding, CACalifornia$651.01$74.81
Rest of CaliforniaCalifornia$651.01$74.81
Riverside, CACalifornia$653.30$77.10

49451 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.

$523.04

$746.36

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

View every state and territory as a table
49451 office rate range by state
State / territoryOffice rate rangeLocalities
AK$663.411
AL$531.951
AR$523.041
AZ$584.291
CA$651.01–$841.7129
CO$635.311
CT$645.751
DC$701.151
DE$595.051
FL$581.87–$634.553
GA$545.44–$612.032
GU$672.241
HI$672.241
IA$552.171
ID$555.381
IL$559.28–$622.164
IN$559.221
KS$547.041
KY$541.891
LA$540.06–$571.272
MA$629.78–$707.372
MD$608.33–$701.153
ME$556.43–$594.482
MI$556.24–$587.972
MN$612.461
MO$527.86–$576.213
MS$525.681
MT$601.871
NC$563.501
ND$597.721
NE$556.321
NH$622.951
NJ$654.18–$691.742
NM$558.881
NV$601.251
NY$573.05–$712.855
OH$555.391
OK$543.071
OR$597.66–$660.442
PA$557.62–$626.252
PR$607.661
RI$619.921
SC$560.171
SD$597.231
TN$549.941
TX$553.23–$632.248
UT$569.061
VA$590.73–$701.152
VI$607.661
VT$593.071
WA$629.34–$725.052
WI$574.561
WV$534.811
WY$600.061

See 49451 in every payment locality

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

Office or facility?

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.

The exact San Francisco, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,817

Code
49451
Physician work
1.79
Practice expense
16.02
Malpractice
0.21

GPCI2026.csv

24

Locality
San Francisco, CA
Physician work
1.095
Practice expense
1.410
Malpractice
0.425
Office calculation for 49451 in San Francisco, CA
ComponentRVULocality factorAdjusted
Physician work1.79× 1.0951.9601
Practice expense16.02× 1.41022.5882
Malpractice0.21× 0.4250.0892
Total RVUs24.6375
Conversion factor× 33.4009

Office rate, San Francisco, CA$822.91

Office: (1.79 × 1.095 + 16.02 × 1.41 + 0.21 × 0.425) × $33.4009 = $822.91

Facility: (1.79 × 1.095 + 0.28 × 1.41 + 0.21 × 0.425) × $33.4009 = $81.64

Open 49451 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 49451

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

Codes related to 49451
CodeHow it relatesOffice range, San Francisco, CA
Used instead
49441Enteral tube placement, duodenal or jejunal tubeUsed for percutaneous placement of a duodenal or jejunal tube rather than exchange through an existing tract.$1,314.37
49446Tube conversion, G-tube to G-J tubeConverts a gastrostomy tube to a gastrojejunal tube rather than replacing a duodenostomy or jejunostomy tube.$1,033.73
Same family
49450Feeding tube replacement, gastrostomy or cecostomyPercutaneous replacement code for a gastrostomy or cecostomy tube.$776.51
49452G-J tube replacement, percutaneous exchangePercutaneous replacement code for a gastrojejunal tube.$986.51

How 49451 has changed in San Francisco, CA

49451 · Office / nonfacility

$822.91

Effective 2026-10-01

The base rate is $16.29 higher than on 2025-10-01, moving from $806.62 to $822.91 (2.0%).

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

    $806.62changed to$822.91

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.84 changed to 1.79
    • Practice expense RVU 16.10 changed to 16.02
    • Malpractice RVU 0.20 changed to 0.21
    • Work GPCI 1.088 changed to 1.095
    • Practice expense GPCI 1.419 changed to 1.410
    • Malpractice GPCI 0.445 changed to 0.425

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $857.95changed to$806.62

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 16.69 changed to 16.10

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $843.95changed to$857.95

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $877.28changed to$843.95

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 17.33 changed to 16.69
    • Malpractice RVU 0.19 changed to 0.20
    • Work GPCI 1.082 changed to 1.088
    • Practice expense GPCI 1.374 changed to 1.419
    • Malpractice GPCI 0.452 changed to 0.445

  5. January 1, 2023

    RVU23A

    $894.38changed to$877.28

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 17.89 changed to 17.33
    • Work GPCI 1.077 changed to 1.082
    • Practice expense GPCI 1.329 changed to 1.374
    • Malpractice GPCI 0.458 changed to 0.452

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $952.49changed to$894.38

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 18.99 changed to 17.89
    • Malpractice RVU 0.17 changed to 0.19

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $951.19changed to$952.49

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 18.31 changed to 18.99
    • Malpractice RVU 0.18 changed to 0.17
    • Work GPCI 1.076 changed to 1.077
    • Practice expense GPCI 1.327 changed to 1.329
    • Malpractice GPCI 0.440 changed to 0.458

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $954.08changed to$951.19

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 18.43 changed to 18.31
    • Work GPCI 1.075 changed to 1.076
    • Practice expense GPCI 1.325 changed to 1.327
    • Malpractice GPCI 0.421 changed to 0.440

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $964.01changed to$954.08

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 18.66 changed to 18.43

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $980.77changed to$964.01

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 18.62 changed to 18.66
    • Work GPCI 1.077 changed to 1.075
    • Practice expense GPCI 1.357 changed to 1.325
    • Malpractice GPCI 0.439 changed to 0.421

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1004.84changed to$980.77

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 18.73 changed to 18.62
    • Work GPCI 1.079 changed to 1.077
    • Practice expense GPCI 1.388 changed to 1.357
    • Malpractice GPCI 0.457 changed to 0.439

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1005.14changed to$1004.84

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 18.66 changed to 18.73
    • Malpractice RVU 0.19 changed to 0.18

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $1000.14changed to$1005.14

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $994.66changed to$1000.14

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 18.70 changed to 18.66
    • Work GPCI 1.076 changed to 1.079
    • Practice expense GPCI 1.374 changed to 1.388
    • Malpractice GPCI 0.487 changed to 0.457

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $1011.78changed to$994.66

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 20.34 changed to 18.70
    • Malpractice RVU 0.20 changed to 0.19
    • Work GPCI 1.072 changed to 1.076
    • Practice expense GPCI 1.360 changed to 1.374
    • Malpractice GPCI 0.516 changed to 0.487

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$1011.78

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$822.91$81.64RVU26D
2026-07-01$822.91$81.64RVU26C
2026-04-01$822.91$81.64RVU26B
2026-01-01$822.91$81.64RVU26A
2025-10-01$806.62$93.34RVU25D
2025-07-01$806.62$93.34RVU25C
2025-04-01$806.62$93.34RVU25B
2025-01-01$806.62$93.34RVU25A
2024-10-01$857.95$95.11RVU24D
2024-07-01$857.95$95.11RVU24C
2024-04-01$857.95$95.11RVU24B
2024-03-09$857.95$95.11RVU24AR
2024-01-01$843.95$93.56RVU24A
2023-10-01$877.28$96.45RVU23D
2023-07-01$877.28$96.45RVU23C
2023-04-01$877.28$96.45RVU23B
2023-01-01$877.28$96.45RVU23A
2022-10-01$894.38$97.35RVU22D
2022-07-01$894.38$97.35RVU22C
2022-04-01$894.38$97.35RVU22B
2022-01-01$894.38$97.35RVU22A
2021-10-01$952.49$97.83RVU21D
2021-07-01$952.49$97.83RVU21C
2021-04-01$952.49$97.83RVU21B
2021-01-01$952.49$97.83RVU21A
2020-10-01$951.19$102.57RVU20D
2020-07-01$951.19$102.57RVU20C
2020-04-01$951.19$102.57RVU20B
2020-01-01$951.19$102.57RVU20A
2019-10-01$954.08$102.67RVU19D
2019-07-01$954.08$102.67RVU19C
2019-04-01$954.08$102.67RVU19B
2019-01-01$954.08$102.67RVU19A
2018-10-01$964.01$102.55RVU18D
2018-07-01$964.01$102.55RVU18C
2018-04-01$964.01$102.55RVU18B
2018-01-01$964.01$102.55RVU18AR1
2017-10-01$980.77$103.66RVU17D
2017-07-01$980.77$103.66RVU17C
2017-04-01$980.77$103.66RVU17B
2017-01-01$980.77$103.66RVU17A
2016-10-01$1,004.84$104.84RVU16D
2016-07-01$1,004.84$104.84RVU16C
2016-04-01$1,004.84$104.84RVU16B
2016-01-01$1,004.84$104.84RVU16A
2015-10-01$1,005.14$105.38RVU15D
2015-07-01$1,005.14$105.38RVU15C
2015-04-01$1,000.14$104.86RVU15B
2015-01-01$1,000.14$104.86RVU15A
2014-10-01$994.66$105.25RVU14D
2014-07-01$994.66$105.25RVU14C
2014-04-01$994.66$105.25RVU14B
2014-01-01$994.66$105.25RVU14A
2013-10-01$1,011.78$100.70RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 49451 for an earlier date of service

Where the San Francisco, CA rate applies

San Francisco, CA is a Medicare payment area, not a city. Our Census mapping connects it to 107 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Alameda
  • Berkeley
  • Oakland
  • San Francisco
  • San Mateo
  • Acalanes Ridge
  • Alamo
  • Albany

Browse all communities in California

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

Show the CMS file lines behind this rate
RVUs for 49451PPRRVU2026_Oct_nonQPP.csv, line 5,817 (RVU26D)
Geographic factors for San Francisco, CAGPCI2026.csv, line 24 (RVU26D)

Open CMS sourceHow we calculate rates

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