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

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 Connecticut, Medicare pays $645.75 for 49451 in the office and $79.54 when it’s performed in a hospital or facility.

$645.75Office (non-facility)
$79.54Hospital or facility
+7.3%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 Connecticut
  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 Connecticut 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. Connecticut pays $645.75. The RVUs are the same everywhere; the geographic indexes change the dollars.

49451 in Connecticut vs other payment areas
  1. Connecticut · this page$645.75
  2. Los Angeles, CA · California$699.90+$54.15
  3. Washington, DC area · District of Columbia$701.15+$55.40
  4. Miami, FL · Florida$634.55−$11.20
  5. Chicago, IL · Illinois$614.06−$31.69
  6. Manhattan, NY · New York$696.50+$50.75
  7. Alaska · Alaska$663.41+$17.66

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

Every other payment area

49451 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$531.95$71.94
ArkansasArkansas$523.04$71.43
ArizonaArizona$584.29$74.85
Bakersfield, CACalifornia$651.65$75.45
Chico, CACalifornia$651.01$74.81
El Centro, CACalifornia$651.05$74.85
Fresno, CACalifornia$651.01$74.81
Hanford, CACalifornia$651.01$74.81

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 Connecticut 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

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Office calculation for 49451 in Connecticut
ComponentRVULocality factorAdjusted
Physician work1.79× 1.0201.8258
Practice expense16.02× 1.07717.2535
Malpractice0.21× 1.2100.2541
Total RVUs19.3334
Conversion factor× 33.4009

Office rate, Connecticut$645.75

Office: (1.79 × 1.02 + 16.02 × 1.077 + 0.21 × 1.21) × $33.4009 = $645.75

Facility: (1.79 × 1.02 + 0.28 × 1.077 + 0.21 × 1.21) × $33.4009 = $79.54

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, Connecticut
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.$1,052.00
49446Tube conversion, G-tube to G-J tubeConverts a gastrostomy tube to a gastrojejunal tube rather than replacing a duodenostomy or jejunostomy tube.$818.22
Same family
49450Feeding tube replacement, gastrostomy or cecostomyPercutaneous replacement code for a gastrostomy or cecostomy tube.$605.71
49452G-J tube replacement, percutaneous exchangePercutaneous replacement code for a gastrojejunal tube.$779.51

How 49451 has changed in Connecticut

49451 · Office / nonfacility

$645.75

Effective 2026-10-01

The base rate is $8.95 higher than on 2025-10-01, moving from $636.80 to $645.75 (1.4%).

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

    $636.80changed to$645.75

    • 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 1.022 changed to 1.020
    • Practice expense GPCI 1.091 changed to 1.077
    • Malpractice GPCI 1.207 changed to 1.210

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $676.76changed to$636.80

    • 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

    $665.71changed to$676.76

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $718.28changed to$665.71

    • 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 1.030 changed to 1.022
    • Practice expense GPCI 1.102 changed to 1.091
    • Malpractice GPCI 1.070 changed to 1.207

  5. January 1, 2023

    RVU23A

    $761.86changed to$718.28

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 17.89 changed to 17.33
    • Work GPCI 1.037 changed to 1.030
    • Practice expense GPCI 1.114 changed to 1.102
    • Malpractice GPCI 0.934 changed to 1.070

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $810.28changed to$761.86

    • 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

    $810.91changed to$810.28

    • 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 1.029 changed to 1.037
    • Practice expense GPCI 1.113 changed to 1.114
    • Malpractice GPCI 1.094 changed to 0.934

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $814.44changed to$810.91

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 18.43 changed to 18.31
    • Work GPCI 1.021 changed to 1.029
    • Practice expense GPCI 1.112 changed to 1.113
    • Malpractice GPCI 1.255 changed to 1.094

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $822.75changed to$814.44

    • 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

    $822.02changed to$822.75

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 18.62 changed to 18.66
    • Work GPCI 1.023 changed to 1.021
    • Practice expense GPCI 1.117 changed to 1.112
    • Malpractice GPCI 1.244 changed to 1.255

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $827.16changed to$822.02

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 18.73 changed to 18.62
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.121 changed to 1.117
    • Malpractice GPCI 1.232 changed to 1.244

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $827.77changed to$827.16

    • 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

    $823.65changed to$827.77

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $823.49changed to$823.65

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 18.70 changed to 18.66
    • Practice expense GPCI 1.116 changed to 1.121
    • Malpractice GPCI 1.234 changed to 1.232

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $840.66changed to$823.49

    • 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
    • Practice expense GPCI 1.110 changed to 1.116
    • Malpractice GPCI 1.235 changed to 1.234

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $840.66

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$645.75$79.54RVU26D
2026-07-01$645.75$79.54RVU26C
2026-04-01$645.75$79.54RVU26B
2026-01-01$645.75$79.54RVU26A
2025-10-01$636.80$88.40RVU25D
2025-07-01$636.80$88.40RVU25C
2025-04-01$636.80$88.40RVU25B
2025-01-01$636.80$88.40RVU25A
2024-10-01$676.76$90.24RVU24D
2024-07-01$676.76$90.24RVU24C
2024-04-01$676.76$90.24RVU24B
2024-03-09$676.76$90.24RVU24AR
2024-01-01$665.71$88.77RVU24A
2023-10-01$718.28$92.02RVU23D
2023-07-01$718.28$92.02RVU23C
2023-04-01$718.28$92.02RVU23B
2023-01-01$718.28$92.02RVU23A
2022-10-01$761.86$93.76RVU22D
2022-07-01$761.86$93.76RVU22C
2022-04-01$761.86$93.76RVU22B
2022-01-01$761.86$93.76RVU22A
2021-10-01$810.28$93.89RVU21D
2021-07-01$810.28$93.89RVU21C
2021-04-01$810.28$93.89RVU21B
2021-01-01$810.28$93.89RVU21A
2020-10-01$810.91$99.14RVU20D
2020-07-01$810.91$99.14RVU20C
2020-04-01$810.91$99.14RVU20B
2020-01-01$810.91$99.14RVU20A
2019-10-01$814.44$99.89RVU19D
2019-07-01$814.44$99.89RVU19C
2019-04-01$814.44$99.89RVU19B
2019-01-01$814.44$99.89RVU19A
2018-10-01$822.75$99.78RVU18D
2018-07-01$822.75$99.78RVU18C
2018-04-01$822.75$99.78RVU18B
2018-01-01$822.75$99.78RVU18AR1
2017-10-01$822.02$100.04RVU17D
2017-07-01$822.02$100.04RVU17C
2017-04-01$822.02$100.04RVU17B
2017-01-01$822.02$100.04RVU17A
2016-10-01$827.16$100.29RVU16D
2016-07-01$827.16$100.29RVU16C
2016-04-01$827.16$100.29RVU16B
2016-01-01$827.16$100.29RVU16A
2015-10-01$827.77$101.09RVU15D
2015-07-01$827.77$101.09RVU15C
2015-04-01$823.65$100.59RVU15B
2015-01-01$823.65$100.59RVU15A
2014-10-01$823.49$101.08RVU14D
2014-07-01$823.49$101.08RVU14C
2014-04-01$823.49$101.08RVU14B
2014-01-01$823.49$101.08RVU14A
2013-10-01$840.66$97.06RVU13D
2013-07-01$840.66$97.06RVU13C
2013-04-01$840.66$97.06RVU13B
2013-01-01$840.66$97.06RVU13AR

Price 49451 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

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 ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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