CPT code 49452: G-J tube replacement, percutaneous exchange2026 Medicare rate & RVUs in Montana
Percutaneous replacement of an existing gastrojejunostomy tube restores enteral access when the tube is displaced, obstructed, damaged, or otherwise needs exchange.
In Montana, Medicare pays $727.45 for 49452 in the office and $116.88 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Montana 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. Montana pays $727.45. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$727.45
- Los Angeles, CA · California$842.17+$114.72
- Washington, DC area · District of Columbia$844.75+$117.30
- Miami, FL · Florida$768.39+$40.94
- Chicago, IL · Illinois$744.22+$16.77
- Manhattan, NY · New York$840.44+$112.99
- Alaska · Alaska$810.14+$82.69
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $784.34 | $115.15 |
| Merced, CACalifornia | $784.34 | $115.15 |
| Modesto, CACalifornia | $784.34 | $115.15 |
| Napa, CACalifornia | $926.93 | $122.20 |
| Oxnard, CACalifornia | $839.92 | $118.23 |
| Redding, CACalifornia | $784.34 | $115.15 |
| Rest of CaliforniaCalifornia | $784.34 | $115.15 |
| Riverside, CACalifornia | $787.61 | $118.42 |
| Sacramento, CACalifornia | $827.93 | $117.84 |
| Salinas, CACalifornia | $824.97 | $117.32 |
| San Diego, CACalifornia | $848.03 | $117.79 |
| Marin County, CACalifornia | $986.85 | $125.95 |
| San Francisco, CACalifornia | $986.51 | $125.61 |
| San Benito County, CACalifornia | $1,009.00 | $128.56 |
| Santa Clara County, CACalifornia | $1,007.60 | $127.16 |
| San Luis Obispo, CACalifornia | $811.18 | $115.74 |
| Santa Cruz, CACalifornia | $859.00 | $117.15 |
| Santa Maria, CACalifornia | $829.06 | $117.14 |
| Santa Rosa, CACalifornia | $867.95 | $118.17 |
| Stockton, CACalifornia | $784.34 | $115.15 |
| Vallejo, CACalifornia | $926.44 | $121.71 |
| Visalia, CACalifornia | $784.34 | $115.15 |
| Yuba City, CACalifornia | $784.34 | $115.15 |
| ColoradoColorado | $766.35 | $116.70 |
| ConnecticutConnecticut | $779.51 | $121.93 |
| DelawareDelaware | $719.43 | $116.19 |
| Fort Lauderdale, FLFlorida | $743.68 | $125.18 |
| Rest of FloridaFlorida | $705.04 | $121.34 |
| Atlanta, GAGeorgia | $739.75 | $119.42 |
| Rest of GeorgiaGeorgia | $661.98 | $117.35 |
| Hawaii, Guam, HIHawaii | $808.78 | $114.56 |
| IowaIowa | $668.37 | $109.70 |
| IdahoIdaho | $672.25 | $110.53 |
| East St. Louis, ILIllinois | $687.69 | $125.97 |
| Rest of IllinoisIllinois | $678.80 | $121.35 |
| Suburban Chicago, ILIllinois | $752.71 | $125.66 |
| IndianaIndiana | $676.75 | $110.75 |
| KansasKansas | $662.57 | $110.62 |
| KentuckyKentucky | $657.33 | $114.53 |
| New Orleans, LALouisiana | $692.00 | $117.46 |
| Rest of LouisianaLouisiana | $655.26 | $114.91 |
| Metropolitan Boston, MAMassachusetts | $851.30 | $122.28 |
| Rest of MassachusettsMassachusetts | $760.01 | $117.09 |
| Baltimore area, MDMaryland | $776.91 | $121.77 |
| Rest of MarylandMaryland | $735.07 | $117.18 |
| Rest of MaineMaine | $673.74 | $112.02 |
| Southern Maine, MEMaine | $718.16 | $113.08 |
| Detroit, MIMichigan | $712.50 | $123.30 |
| Rest of MichiganMichigan | $674.45 | $117.00 |
| MinnesotaMinnesota | $738.52 | $110.25 |
| Metropolitan Kansas City, MOMissouri | $689.16 | $115.84 |
| Metropolitan St. Louis, MOMissouri | $697.53 | $116.27 |
| Rest of MissouriMissouri | $641.06 | $114.75 |
| MississippiMississippi | $638.08 | $112.38 |
| North CarolinaNorth Carolina | $682.03 | $112.37 |
| North DakotaNorth Dakota | $721.52 | $110.95 |
| NebraskaNebraska | $673.17 | $109.62 |
| New HampshireNew Hampshire | $751.81 | $116.21 |
| Northern New JerseyNew Jersey | $833.91 | $125.65 |
| Rest of New JerseyNew Jersey | $789.60 | $122.86 |
| New MexicoNew Mexico | $677.67 | $117.78 |
| NevadaNevada | $726.42 | $115.24 |
| NYC suburbs and Long Island, NYNew York | $860.01 | $134.04 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $793.07 | $124.50 |
| Queens, NYNew York | $851.48 | $129.79 |
| Rest of New YorkNew York | $693.28 | $113.24 |
| OhioOhio | $673.24 | $115.79 |
| OklahomaOklahoma | $658.44 | $113.20 |
| Portland, OROregon | $795.69 | $117.35 |
| Rest of OregonOregon | $722.00 | $113.87 |
| Metropolitan Philadelphia, PAPennsylvania | $756.68 | $121.08 |
| Rest of PennsylvaniaPennsylvania | $675.73 | $115.23 |
| Puerto RicoPuerto Rico | $734.19 | $116.90 |
| Rhode IslandRhode Island | $748.76 | $118.04 |
| South CarolinaSouth Carolina | $678.52 | $114.36 |
| South DakotaSouth Dakota | $720.82 | $110.25 |
| TennesseeTennessee | $666.02 | $111.02 |
| Austin, TXTexas | $762.72 | $116.74 |
| Beaumont, TXTexas | $670.58 | $114.96 |
| Brazoria, TXTexas | $720.39 | $115.32 |
| Dallas, TXTexas | $724.39 | $116.26 |
| Fort Worth, TXTexas | $718.28 | $116.26 |
| Galveston, TXTexas | $722.12 | $115.83 |
| Houston, TXTexas | $727.61 | $121.32 |
| Rest of TexasTexas | $694.66 | $115.23 |
| UtahUtah | $688.99 | $115.06 |
| VirginiaVirginia | $713.91 | $113.72 |
| Virgin Islands, VIUnited States Virgin Islands | $734.19 | $116.90 |
| VermontVermont | $716.28 | $111.82 |
| Rest of WashingtonWashington | $759.37 | $116.45 |
| King County, WAWashington | $872.00 | $122.84 |
| WisconsinWisconsin | $694.32 | $109.39 |
| West VirginiaWest Virginia | $650.01 | $119.43 |
| WyomingWyoming | $724.87 | $114.30 |
49452 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $810.14 | 1 |
| AL | $645.09 | 1 |
| AR | $634.59 | 1 |
| AZ | $706.68 | 1 |
| CA | $784.34–$1,009.00 | 29 |
| CO | $766.35 | 1 |
| CT | $779.51 | 1 |
| DC | $844.75 | 1 |
| DE | $719.43 | 1 |
| FL | $705.04–$768.39 | 3 |
| GA | $661.98–$739.75 | 2 |
| GU | $808.78 | 1 |
| HI | $808.78 | 1 |
| IA | $668.37 | 1 |
| ID | $672.25 | 1 |
| IL | $678.80–$752.71 | 4 |
| IN | $676.75 | 1 |
| KS | $662.57 | 1 |
| KY | $657.33 | 1 |
| LA | $655.26–$692.00 | 2 |
| MA | $760.01–$851.30 | 2 |
| MD | $735.07–$844.75 | 3 |
| ME | $673.74–$718.16 | 2 |
| MI | $674.45–$712.50 | 2 |
| MN | $738.52 | 1 |
| MO | $641.06–$697.53 | 3 |
| MS | $638.08 | 1 |
| MT | $727.45 | 1 |
| NC | $682.03 | 1 |
| ND | $721.52 | 1 |
| NE | $673.17 | 1 |
| NH | $751.81 | 1 |
| NJ | $789.60–$833.91 | 2 |
| NM | $677.67 | 1 |
| NV | $726.42 | 1 |
| NY | $693.28–$860.01 | 5 |
| OH | $673.24 | 1 |
| OK | $658.44 | 1 |
| OR | $722.00–$795.69 | 2 |
| PA | $675.73–$756.68 | 2 |
| PR | $734.19 | 1 |
| RI | $748.76 | 1 |
| SC | $678.52 | 1 |
| SD | $720.82 | 1 |
| TN | $666.02 | 1 |
| TX | $670.58–$762.72 | 8 |
| UT | $688.99 | 1 |
| VA | $713.91–$844.75 | 2 |
| VI | $734.19 | 1 |
| VT | $716.28 | 1 |
| WA | $759.37–$872.00 | 2 |
| WI | $694.32 | 1 |
| WV | $650.01 | 1 |
| WY | $724.87 | 1 |
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
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 Montana 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
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.79 | × 1.000 | 2.7900 |
| Practice expense | 18.69 | × 1.000 | 18.6900 |
| Malpractice | 0.30 | × 0.998 | 0.2994 |
| Total RVUs | 21.7794 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$727.45
Office: (2.79 × 1 + 18.69 × 1 + 0.3 × 0.998) × $33.4009 = $727.45
Facility: (2.79 × 1 + 0.41 × 1 + 0.3 × 0.998) × $33.4009 = $116.88
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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%).
How 49452 has changed in Montana
49452 · Office / nonfacility
$727.45
Effective 2026-10-01
The base rate is $14.09 higher than on 2025-10-01, moving from $713.36 to $727.45 (2.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$713.36changed to$727.45
- 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
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$756.74changed to$713.36
- 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.
March 9, 2024
RVU24AR
$744.39changed to$756.74
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$796.47changed to$744.39
- 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
January 1, 2023
RVU23A
$833.81changed to$796.47
- 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
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$890.97changed to$833.81
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 22.43 changed to 20.99
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$901.12changed to$890.97
- 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
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$912.43changed to$901.12
- 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
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$927.14changed to$912.43
- 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.
January 1, 2018
RVU18AR1
$919.73changed to$927.14
- 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
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$920.40changed to$919.73
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 22.54 changed to 22.41
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$922.25changed to$920.40
- 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.
July 1, 2015
RVU15C
$917.66changed to$922.25
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$917.53changed to$917.66
- Conversion factor 35.8228 changed to 35.7547
- Malpractice RVU 0.26 changed to 0.29
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
$935.90changed to$917.53
- 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
- Malpractice GPCI 1.103 changed to 1.165
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $935.90
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $727.45 | $116.88 | RVU26D |
| 2026-07-01 | $727.45 | $116.88 | RVU26C |
| 2026-04-01 | $727.45 | $116.88 | RVU26B |
| 2026-01-01 | $727.45 | $116.88 | RVU26A |
| 2025-10-01 | $713.36 | $129.18 | RVU25D |
| 2025-07-01 | $713.36 | $129.18 | RVU25C |
| 2025-04-01 | $713.36 | $129.18 | RVU25B |
| 2025-01-01 | $713.36 | $129.18 | RVU25A |
| 2024-10-01 | $756.74 | $131.93 | RVU24D |
| 2024-07-01 | $756.74 | $131.93 | RVU24C |
| 2024-04-01 | $756.74 | $131.93 | RVU24B |
| 2024-03-09 | $756.74 | $131.93 | RVU24AR |
| 2024-01-01 | $744.39 | $129.78 | RVU24A |
| 2023-10-01 | $796.47 | $135.33 | RVU23D |
| 2023-07-01 | $796.47 | $135.33 | RVU23C |
| 2023-04-01 | $796.47 | $135.33 | RVU23B |
| 2023-01-01 | $796.47 | $135.33 | RVU23A |
| 2022-10-01 | $833.81 | $136.84 | RVU22D |
| 2022-07-01 | $833.81 | $136.84 | RVU22C |
| 2022-04-01 | $833.81 | $136.84 | RVU22B |
| 2022-01-01 | $833.81 | $136.84 | RVU22A |
| 2021-10-01 | $890.97 | $138.32 | RVU21D |
| 2021-07-01 | $890.97 | $138.32 | RVU21C |
| 2021-04-01 | $890.97 | $138.32 | RVU21B |
| 2021-01-01 | $890.97 | $138.32 | RVU21A |
| 2020-10-01 | $901.12 | $147.93 | RVU20D |
| 2020-07-01 | $901.12 | $147.93 | RVU20C |
| 2020-04-01 | $901.12 | $147.93 | RVU20B |
| 2020-01-01 | $901.12 | $147.93 | RVU20A |
| 2019-10-01 | $912.43 | $150.20 | RVU19D |
| 2019-07-01 | $912.43 | $150.20 | RVU19C |
| 2019-04-01 | $912.43 | $150.20 | RVU19B |
| 2019-01-01 | $912.43 | $150.20 | RVU19A |
| 2018-10-01 | $927.14 | $150.98 | RVU18D |
| 2018-07-01 | $927.14 | $150.98 | RVU18C |
| 2018-04-01 | $927.14 | $150.98 | RVU18B |
| 2018-01-01 | $927.14 | $150.98 | RVU18AR1 |
| 2017-10-01 | $919.73 | $149.20 | RVU17D |
| 2017-07-01 | $919.73 | $149.20 | RVU17C |
| 2017-04-01 | $919.73 | $149.20 | RVU17B |
| 2017-01-01 | $919.73 | $149.20 | RVU17A |
| 2016-10-01 | $920.40 | $147.39 | RVU16D |
| 2016-07-01 | $920.40 | $147.39 | RVU16C |
| 2016-04-01 | $920.40 | $147.39 | RVU16B |
| 2016-01-01 | $920.40 | $147.39 | RVU16A |
| 2015-10-01 | $922.25 | $149.68 | RVU15D |
| 2015-07-01 | $922.25 | $149.68 | RVU15C |
| 2015-04-01 | $917.66 | $148.94 | RVU15B |
| 2015-01-01 | $917.66 | $148.94 | RVU15A |
| 2014-10-01 | $917.53 | $148.05 | RVU14D |
| 2014-07-01 | $917.53 | $148.05 | RVU14C |
| 2014-04-01 | $917.53 | $148.05 | RVU14B |
| 2014-01-01 | $917.53 | $148.05 | RVU14A |
| 2013-10-01 | $935.90 | $141.46 | RVU13D |
| 2013-07-01 | $935.90 | $141.46 | RVU13C |
| 2013-04-01 | $935.90 | $141.46 | RVU13B |
| 2013-01-01 | $935.90 | $141.46 | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
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
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