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

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 Washington, DC area, Medicare pays $701.15 for 49451 in the office and $81.84 when it’s performed in a hospital or facility.

$701.15Office (non-facility)
$81.84Hospital or facility
+16.5%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 Washington, DC area
  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 Washington, DC area 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. Washington, DC area pays $701.15. The RVUs are the same everywhere; the geographic indexes change the dollars.

49451 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$701.15
  2. Los Angeles, CA · California$699.90−$1.25
  3. Miami, FL · Florida$634.55−$66.60
  4. Chicago, IL · Illinois$614.06−$87.09
  5. Manhattan, NY · New York$696.50−$4.65
  6. Alaska · Alaska$663.41−$37.74
  7. Alabama · Alabama$531.95−$169.20

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

49451 in every other Medicare payment locality
Payment localityOfficeFacility
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
Madera, 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 Washington, DC area 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

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 49451 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work1.79× 1.0541.8867
Practice expense16.02× 1.17818.8716
Malpractice0.21× 1.1130.2337
Total RVUs20.9919
Conversion factor× 33.4009

Office rate, Washington, DC area$701.15

Office: (1.79 × 1.054 + 16.02 × 1.178 + 0.21 × 1.113) × $33.4009 = $701.15

Facility: (1.79 × 1.054 + 0.28 × 1.178 + 0.21 × 1.113) × $33.4009 = $81.84

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, Washington, DC area
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.$1,136.58
49446Tube conversion, G-tube to G-J tubeConverts a gastrostomy tube to a gastrojejunal tube rather than replacing a duodenostomy or jejunostomy tube.$886.35
Same family
49450Feeding tube replacement, gastrostomy or cecostomyPercutaneous replacement code for a gastrostomy or cecostomy tube.$658.72
49452G-J tube replacement, percutaneous exchangePercutaneous replacement code for a gastrojejunal tube.$844.75

How 49451 has changed in Washington, DC area

49451 · Office / nonfacility

$701.15

Effective 2026-10-01

The base rate is $9.92 higher than on 2025-10-01, moving from $691.23 to $701.15 (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

    $691.23changed to$701.15

    • 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 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $734.75changed to$691.23

    • 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

    $722.76changed to$734.75

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $786.71changed to$722.76

    • 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 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $840.84changed to$786.71

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 17.89 changed to 17.33
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $894.34changed to$840.84

    • 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

    $884.79changed to$894.34

    • 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 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $877.84changed to$884.79

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 18.43 changed to 18.31
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $886.85changed to$877.84

    • 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

    $882.65changed to$886.85

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 18.62 changed to 18.66
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $885.58changed to$882.65

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 18.73 changed to 18.62
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $886.20changed to$885.58

    • 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

    $881.79changed to$886.20

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $882.61changed to$881.79

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 18.70 changed to 18.66
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $902.41changed to$882.61

    • 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 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $902.41

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$701.15$81.84RVU26D
2026-07-01$701.15$81.84RVU26C
2026-04-01$701.15$81.84RVU26B
2026-01-01$701.15$81.84RVU26A
2025-10-01$691.23$92.06RVU25D
2025-07-01$691.23$92.06RVU25C
2025-04-01$691.23$92.06RVU25B
2025-01-01$691.23$92.06RVU25A
2024-10-01$734.75$93.94RVU24D
2024-07-01$734.75$93.94RVU24C
2024-04-01$734.75$93.94RVU24B
2024-03-09$734.75$93.94RVU24AR
2024-01-01$722.76$92.41RVU24A
2023-10-01$786.71$96.81RVU23D
2023-07-01$786.71$96.81RVU23C
2023-04-01$786.71$96.81RVU23B
2023-01-01$786.71$96.81RVU23A
2022-10-01$840.84$99.58RVU22D
2022-07-01$840.84$99.58RVU22C
2022-04-01$840.84$99.58RVU22B
2022-01-01$840.84$99.58RVU22A
2021-10-01$894.34$99.50RVU21D
2021-07-01$894.34$99.50RVU21C
2021-04-01$894.34$99.50RVU21B
2021-01-01$894.34$99.50RVU21A
2020-10-01$884.79$103.95RVU20D
2020-07-01$884.79$103.95RVU20C
2020-04-01$884.79$103.95RVU20B
2020-01-01$884.79$103.95RVU20A
2019-10-01$877.84$103.53RVU19D
2019-07-01$877.84$103.53RVU19C
2019-04-01$877.84$103.53RVU19B
2019-01-01$877.84$103.53RVU19A
2018-10-01$886.85$103.42RVU18D
2018-07-01$886.85$103.42RVU18C
2018-04-01$886.85$103.42RVU18B
2018-01-01$886.85$103.42RVU18AR1
2017-10-01$882.65$103.80RVU17D
2017-07-01$882.65$103.80RVU17C
2017-04-01$882.65$103.80RVU17B
2017-01-01$882.65$103.80RVU17A
2016-10-01$885.58$104.24RVU16D
2016-07-01$885.58$104.24RVU16C
2016-04-01$885.58$104.24RVU16B
2016-01-01$885.58$104.24RVU16A
2015-10-01$886.20$105.07RVU15D
2015-07-01$886.20$105.07RVU15C
2015-04-01$881.79$104.55RVU15B
2015-01-01$881.79$104.55RVU15A
2014-10-01$882.61$104.54RVU14D
2014-07-01$882.61$104.54RVU14C
2014-04-01$882.61$104.54RVU14B
2014-01-01$882.61$104.54RVU14A
2013-10-01$902.41$99.85RVU13D
2013-07-01$902.41$99.85RVU13C
2013-04-01$902.41$99.85RVU13B
2013-01-01$902.41$99.85RVU13AR

Price 49451 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

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 Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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