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

Percutaneous replacement of an existing gastrojejunostomy tube restores enteral access when the tube is displaced, obstructed, damaged, or otherwise needs exchange.

CMS RVU26DEffective Oct 1, 2026One payment locality10.7K Medicare services in 2024

In Washington, DC area, Medicare pays $844.75 for 49452 in the office and $125.51 when it’s performed in a hospital or facility.

$844.75Office (non-facility)
$125.51Hospital or facility
+16.1%vs the national office rate ($727.47)

Check a contract rate as a % of Medicare · 49452 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 49452 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 49452 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 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.

How Washington, DC area compares for 49452

Across 109 of 109 payment localities, the office rate for 49452 runs from $634.59 in Arkansas to $1,009.00 in San Benito County, CA. Washington, DC area pays $844.75. The RVUs are the same everywhere; the geographic indexes change the dollars.

49452 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$844.75
  2. Los Angeles, CA · California$842.17−$2.58
  3. Miami, FL · Florida$768.39−$76.36
  4. Chicago, IL · Illinois$744.22−$100.53
  5. Manhattan, NY · New York$840.44−$4.31
  6. Alaska · Alaska$810.14−$34.61
  7. Alabama · Alabama$645.09−$199.66

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

Every other payment area

49452 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$634.59$110.11
ArizonaArizona$706.68$115.04
Bakersfield, CACalifornia$785.25$116.07
Chico, CACalifornia$784.34$115.15
El Centro, CACalifornia$784.39$115.20
Fresno, CACalifornia$784.34$115.15
Hanford, CACalifornia$784.34$115.15
Madera, CACalifornia$784.34$115.15

49452 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.

$634.59

$896.67

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

View every state and territory as a table
49452 office rate range by state
State / territoryOffice rate rangeLocalities
AK$810.141
AL$645.091
AR$634.591
AZ$706.681
CA$784.34–$1,009.0029
CO$766.351
CT$779.511
DC$844.751
DE$719.431
FL$705.04–$768.393
GA$661.98–$739.752
GU$808.781
HI$808.781
IA$668.371
ID$672.251
IL$678.80–$752.714
IN$676.751
KS$662.571
KY$657.331
LA$655.26–$692.002
MA$760.01–$851.302
MD$735.07–$844.753
ME$673.74–$718.162
MI$674.45–$712.502
MN$738.521
MO$641.06–$697.533
MS$638.081
MT$727.451
NC$682.031
ND$721.521
NE$673.171
NH$751.811
NJ$789.60–$833.912
NM$677.671
NV$726.421
NY$693.28–$860.015
OH$673.241
OK$658.441
OR$722.00–$795.692
PA$675.73–$756.682
PR$734.191
RI$748.761
SC$678.521
SD$720.821
TN$666.021
TX$670.58–$762.728
UT$688.991
VA$713.91–$844.752
VI$734.191
VT$716.281
WA$759.37–$872.002
WI$694.321
WV$650.011
WY$724.871

See 49452 in every payment locality

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.

How the rate is built · 49452

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.79

2.79 RVUs× 1.000 GPCI

Practice expense18.69

18.69 RVUs× 1.000 GPCI

Malpractice0.30

0.30 RVUs× 1.000 GPCI

Adjusted RVUs

21.7800

Conversion factor

$33.4009

Medicare rate

$727.47

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

5,818

Code
49452
Physician work
2.79
Practice expense
18.69
Malpractice
0.30

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 49452 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work2.79× 1.0542.9407
Practice expense18.69× 1.17822.0168
Malpractice0.30× 1.1130.3339
Total RVUs25.2914
Conversion factor× 33.4009

Office rate, Washington, DC area$844.75

Office: (2.79 × 1.054 + 18.69 × 1.178 + 0.3 × 1.113) × $33.4009 = $844.75

Facility: (2.79 × 1.054 + 0.41 × 1.178 + 0.3 × 1.113) × $33.4009 = $125.51

Open 49452 in the RVU calculator

Payment rules and modifiers for 49452

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

CMS payment indicators · 49452

G-J tube replacement, percutaneous exchange

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

49452 without 51 · national office

$727.47

G-J tube replacement, percutaneous exchange

49452-51 · Second procedure: 50%

$363.74

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 49452

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

Codes related to 49452
CodeHow it relatesOffice range, Washington, DC area
Same family
49450Feeding tube replacement, gastrostomy or cecostomyPercutaneous replacement for a gastrostomy or cecostomy tube rather than a G-J tube.$658.72
49451Feeding tube exchange, duodenal or jejunal tubePercutaneous replacement for a duodenostomy or jejunostomy tube rather than a G-J tube.$701.15
Used instead
49446Tube conversion, G-tube to G-J tubeConverts an existing gastrostomy tube to a G-J tube instead of replacing an existing G-J tube.$886.35

How 49452 has changed in Washington, DC area

49452 · Office / nonfacility

$844.75

Effective 2026-10-01

The base rate is $6.90 higher than on 2025-10-01, moving from $837.85 to $844.75 (0.8%).

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

    $837.85changed to$844.75

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.86 changed to 2.79
    • Practice expense RVU 18.91 changed to 18.69
    • Malpractice RVU 0.29 changed to 0.30
    • 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

    $889.20changed to$837.85

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 19.58 changed to 18.91
    • Malpractice RVU 0.30 changed to 0.29

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $874.69changed to$889.20

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $952.03changed to$874.69

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 20.36 changed to 19.58
    • Malpractice RVU 0.29 changed to 0.30
    • 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

    $1013.32changed to$952.03

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 20.99 changed to 20.36
    • Malpractice RVU 0.25 changed to 0.29
    • 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

    $1083.83changed to$1013.32

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 22.43 changed to 20.99

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $1079.56changed to$1083.83

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 21.77 changed to 22.43
    • Malpractice RVU 0.26 changed to 0.25
    • 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

    $1076.64changed to$1079.56

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 22.05 changed to 21.77
    • Malpractice RVU 0.25 changed to 0.26
    • 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

    $1094.13changed to$1076.64

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 22.47 changed to 22.05
    • Malpractice RVU 0.26 changed to 0.25

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $1088.11changed to$1094.13

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 22.41 changed to 22.47
    • Malpractice RVU 0.25 changed to 0.26
    • 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

    $1091.55changed to$1088.11

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 22.54 changed to 22.41
    • 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

    $1093.43changed to$1091.55

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 22.45 changed to 22.54
    • Malpractice RVU 0.29 changed to 0.25

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $1087.99changed to$1093.43

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1085.47changed to$1087.99

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.26 changed to 0.29
    • 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

    $1104.95changed to$1085.47

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 24.35 changed to 22.45
    • Malpractice RVU 0.27 changed to 0.26
    • 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: $1104.95

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$844.75$125.51RVU26D
2026-07-01$844.75$125.51RVU26C
2026-04-01$844.75$125.51RVU26B
2026-01-01$844.75$125.51RVU26A
2025-10-01$837.85$141.51RVU25D
2025-07-01$837.85$141.51RVU25C
2025-04-01$837.85$141.51RVU25B
2025-01-01$837.85$141.51RVU25A
2024-10-01$889.20$144.43RVU24D
2024-07-01$889.20$144.43RVU24C
2024-04-01$889.20$144.43RVU24B
2024-03-09$889.20$144.43RVU24AR
2024-01-01$874.69$142.08RVU24A
2023-10-01$952.03$149.41RVU23D
2023-07-01$952.03$149.41RVU23C
2023-04-01$952.03$149.41RVU23B
2023-01-01$952.03$149.41RVU23A
2022-10-01$1,013.32$151.87RVU22D
2022-07-01$1,013.32$151.87RVU22C
2022-04-01$1,013.32$151.87RVU22B
2022-01-01$1,013.32$151.87RVU22A
2021-10-01$1,083.83$153.56RVU21D
2021-07-01$1,083.83$153.56RVU21C
2021-04-01$1,083.83$153.56RVU21B
2021-01-01$1,083.83$153.56RVU21A
2020-10-01$1,079.56$159.92RVU20D
2020-07-01$1,079.56$159.92RVU20C
2020-04-01$1,079.56$159.92RVU20B
2020-01-01$1,079.56$159.92RVU20A
2019-10-01$1,076.64$158.16RVU19D
2019-07-01$1,076.64$158.16RVU19C
2019-04-01$1,076.64$158.16RVU19B
2019-01-01$1,076.64$158.16RVU19A
2018-10-01$1,094.13$158.87RVU18D
2018-07-01$1,094.13$158.87RVU18C
2018-04-01$1,094.13$158.87RVU18B
2018-01-01$1,094.13$158.87RVU18AR1
2017-10-01$1,088.11$159.62RVU17D
2017-07-01$1,088.11$159.62RVU17C
2017-04-01$1,088.11$159.62RVU17B
2017-01-01$1,088.11$159.62RVU17A
2016-10-01$1,091.55$160.07RVU16D
2016-07-01$1,091.55$160.07RVU16C
2016-04-01$1,091.55$160.07RVU16B
2016-01-01$1,091.55$160.07RVU16A
2015-10-01$1,093.43$162.48RVU15D
2015-07-01$1,093.43$162.48RVU15C
2015-04-01$1,087.99$161.68RVU15B
2015-01-01$1,087.99$161.68RVU15A
2014-10-01$1,085.47$160.57RVU14D
2014-07-01$1,085.47$160.57RVU14C
2014-04-01$1,085.47$160.57RVU14B
2014-01-01$1,085.47$160.57RVU14A
2013-10-01$1,104.95$153.21RVU13D
2013-07-01$1,104.95$153.21RVU13C
2013-04-01$1,104.95$153.21RVU13B
2013-01-01$1,104.95$153.21RVU13AR

Price 49452 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

49452 billing questions

How is 49452 different from replacing a G-tube or a jejunal tube?

Use 49452 when the existing tube is a gastrojejunostomy tube. Code 49450 addresses a gastrostomy or cecostomy tube, while 49451 addresses a duodenostomy or jejunostomy tube.

Can fluoroscopy be reported separately with 49452?

Fluoroscopy used to guide or verify the replacement is included when performed. Do not separately report it as a distinct imaging service for that same exchange.

What documentation supports reporting 49452?

Document the existing G-J tube, why it needed replacement, the percutaneous access used, the tube placed, and imaging or position confirmation when performed.

Does modifier 50 apply, and when can an assistant be paid?

Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeon and team-surgery reporting are not permitted.

How does the 0-day global period affect same-day care?

Same-day preoperative and postoperative care is included in the procedure. If other procedures are performed in the same session, CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full and others at 50%.

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 49452PPRRVU2026_Oct_nonQPP.csv, line 5,818 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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