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

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 Hawaii, Guam, HI, Medicare pays $808.78 for 49452 in the office and $114.56 when it’s performed in a hospital or facility.

$808.78Office (non-facility)
$114.56Hospital or facility
+11.2%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 Hawaii, Guam, HI
  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 Hawaii, Guam, HI 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. Hawaii, Guam, HI pays $808.78. The RVUs are the same everywhere; the geographic indexes change the dollars.

49452 in Hawaii, Guam, HI vs other payment areas
  1. Hawaii, Guam, HI · this page$808.78
  2. Los Angeles, CA · California$842.17+$33.39
  3. Washington, DC area · District of Columbia$844.75+$35.97
  4. Miami, FL · Florida$768.39−$40.39
  5. Chicago, IL · Illinois$744.22−$64.56
  6. Manhattan, NY · New York$840.44+$31.66
  7. Alaska · Alaska$810.14+$1.36

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

Every other payment area

49452 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$645.09$110.84
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

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 Hawaii, Guam, HI 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

46

Locality
Hawaii, Guam, HI
Physician work
1.000
Practice expense
1.137
Malpractice
0.579
Office calculation for 49452 in Hawaii, Guam, HI
ComponentRVULocality factorAdjusted
Physician work2.79× 1.0002.7900
Practice expense18.69× 1.13721.2505
Malpractice0.30× 0.5790.1737
Total RVUs24.2142
Conversion factor× 33.4009

Office rate, Hawaii, Guam, HI$808.78

Office: (2.79 × 1 + 18.69 × 1.137 + 0.3 × 0.579) × $33.4009 = $808.78

Facility: (2.79 × 1 + 0.41 × 1.137 + 0.3 × 0.579) × $33.4009 = $114.56

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, Hawaii, Guam, HI
Same family
49450Feeding tube replacement, gastrostomy or cecostomyPercutaneous replacement for a gastrostomy or cecostomy tube rather than a G-J tube.$632.55
49451Feeding tube exchange, duodenal or jejunal tubePercutaneous replacement for a duodenostomy or jejunostomy tube rather than a G-J tube.$672.24
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.$847.99

How 49452 has changed in Hawaii, Guam, HI

49452 · Office / nonfacility

$808.78

Effective 2026-10-01

The base rate is $8.20 higher than on 2025-10-01, moving from $800.58 to $808.78 (1.0%).

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

    $800.58changed to$808.78

    • 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
    • Practice expense GPCI 1.149 changed to 1.137
    • Malpractice GPCI 0.561 changed to 0.579

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $849.69changed to$800.58

    • 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

    $835.82changed to$849.69

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $893.96changed to$835.82

    • 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 1.003 changed to 1.000
    • Practice expense GPCI 1.146 changed to 1.149
    • Malpractice GPCI 0.618 changed to 0.561

  5. January 1, 2023

    RVU23A

    $936.06changed to$893.96

    • 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 1.010 changed to 1.003
    • Practice expense GPCI 1.143 changed to 1.146
    • Malpractice GPCI 0.675 changed to 0.618

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1001.25changed to$936.06

    • 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

    $1008.69changed to$1001.25

    • 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 1.006 changed to 1.010
    • Practice expense GPCI 1.144 changed to 1.143
    • Malpractice GPCI 0.644 changed to 0.675

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $1019.39changed to$1008.69

    • 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 1.001 changed to 1.006
    • Practice expense GPCI 1.146 changed to 1.144
    • Malpractice GPCI 0.614 changed to 0.644

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $1035.82changed to$1019.39

    • 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

    $1036.50changed to$1035.82

    • 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 1.002 changed to 1.001
    • Practice expense GPCI 1.154 changed to 1.146
    • Malpractice GPCI 0.616 changed to 0.614

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1046.01changed to$1036.50

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 22.54 changed to 22.41
    • Work GPCI 1.003 changed to 1.002
    • Practice expense GPCI 1.162 changed to 1.154
    • Malpractice GPCI 0.618 changed to 0.616

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1046.91changed to$1046.01

    • 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

    $1041.70changed to$1046.91

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1040.08changed to$1041.70

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.26 changed to 0.29
    • Work GPCI 1.002 changed to 1.003
    • Practice expense GPCI 1.158 changed to 1.162
    • Malpractice GPCI 0.659 changed to 0.618

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $1059.78changed to$1040.08

    • 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 1.000 changed to 1.002
    • Practice expense GPCI 1.154 changed to 1.158
    • Malpractice GPCI 0.700 changed to 0.659

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$1059.78

  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$808.78$114.56RVU26D
2026-07-01$808.78$114.56RVU26C
2026-04-01$808.78$114.56RVU26B
2026-01-01$808.78$114.56RVU26A
2025-10-01$800.58$129.36RVU25D
2025-07-01$800.58$129.36RVU25C
2025-04-01$800.58$129.36RVU25B
2025-01-01$800.58$129.36RVU25A
2024-10-01$849.69$131.78RVU24D
2024-07-01$849.69$131.78RVU24C
2024-04-01$849.69$131.78RVU24B
2024-03-09$849.69$131.78RVU24AR
2024-01-01$835.82$129.63RVU24A
2023-10-01$893.96$136.29RVU23D
2023-07-01$893.96$136.29RVU23C
2023-04-01$893.96$136.29RVU23B
2023-01-01$893.96$136.29RVU23A
2022-10-01$936.06$139.42RVU22D
2022-07-01$936.06$139.42RVU22C
2022-04-01$936.06$139.42RVU22B
2022-01-01$936.06$139.42RVU22A
2021-10-01$1,001.25$140.98RVU21D
2021-07-01$1,001.25$140.98RVU21C
2021-04-01$1,001.25$140.98RVU21B
2021-01-01$1,001.25$140.98RVU21A
2020-10-01$1,008.69$147.04RVU20D
2020-07-01$1,008.69$147.04RVU20C
2020-04-01$1,008.69$147.04RVU20B
2020-01-01$1,008.69$147.04RVU20A
2019-10-01$1,019.39$145.88RVU19D
2019-07-01$1,019.39$145.88RVU19C
2019-04-01$1,019.39$145.88RVU19B
2019-01-01$1,019.39$145.88RVU19A
2018-10-01$1,035.82$146.35RVU18D
2018-07-01$1,035.82$146.35RVU18C
2018-04-01$1,035.82$146.35RVU18B
2018-01-01$1,035.82$146.35RVU18AR1
2017-10-01$1,036.50$147.30RVU17D
2017-07-01$1,036.50$147.30RVU17C
2017-04-01$1,036.50$147.30RVU17B
2017-01-01$1,036.50$147.30RVU17A
2016-10-01$1,046.01$147.76RVU16D
2016-07-01$1,046.01$147.76RVU16C
2016-04-01$1,046.01$147.76RVU16B
2016-01-01$1,046.01$147.76RVU16A
2015-10-01$1,046.91$149.19RVU15D
2015-07-01$1,046.91$149.19RVU15C
2015-04-01$1,041.70$148.44RVU15B
2015-01-01$1,041.70$148.44RVU15A
2014-10-01$1,040.08$149.03RVU14D
2014-07-01$1,040.08$149.03RVU14C
2014-04-01$1,040.08$149.03RVU14B
2014-01-01$1,040.08$149.03RVU14A
2013-10-01$1,059.78$143.00RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 49452 for an earlier date of service

Where the Hawaii, Guam, HI rate applies

Hawaii, Guam, HI is a Medicare payment area, not a city. Our Census mapping connects it to 163 cities and communities in Hawaii. Some span more than one payment area; confirm with the service ZIP.

  • Ahuimanu
  • Aiea
  • Ainaloa
  • Anahola
  • Black Sands
  • Captain Cook
  • Discovery Harbour
  • East Honolulu

Browse all communities in Hawaii

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 Hawaii, Guam, HIGPCI2026.csv, line 46 (RVU26D)

Open CMS sourceHow we calculate rates

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