CPT code 49452: G-J tube replacement, percutaneous exchange2026 Medicare rate & RVUs

Medicare pays $727.47 for 49452 nationally in the office and $116.90 in a hospital or facility. Local office rates run $634.59–$1,009.00.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 49452 covers

An interventional radiologist or other physician with image-guided access expertise replaces an existing gastrojejunostomy tube through its established percutaneous tract. The service is used when the tube is displaced, obstructed, damaged, or requires exchange while maintaining gastric access and jejunal feeding access. Fluoroscopy may guide the exchange and verify tube position; it is included when performed. This is a replacement service, not initial creation of a gastrostomy or jejunostomy tract.

Report 49452 for percutaneous exchange of a G-J tube, rather than a G-tube or a duodenal or jejunal tube alone. The record should identify the existing tube, reason for replacement, access used, device placed, and any imaging confirmation. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate; assistant-at-surgery payment requires medical-necessity documentation, and co-surgeon and team-surgery reporting 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 49452 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

49452 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 49452 rate is calculated

Each of 49452’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.

Payment rules and modifiers for 49452

The CMS indicators that decide how 49452 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

49452 compared with similar codes

How to choose

49450Feeding tube replacementGastrostomy or cecostomy

Choose 49450 for percutaneous replacement of a gastrostomy or cecostomy tube. Choose 49452 when the existing tube is a gastrojejunostomy tube.

49451Feeding tube exchangeDuodenal or jejunal tube

Choose 49451 for replacement of a duodenostomy or jejunostomy tube. Code 49452 is for replacement of a tube that provides both gastric and jejunal access.

49446Tube conversionG-tube to G-J tube

Code 49446 describes changing an existing gastrostomy tube to a G-J tube. Code 49452 replaces a G-J tube that is already in place.

Codes related to 49452

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

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

Open CMS sourceHow we calculate rates