CPT code 49460: Tube fixation, gastrostomy or cecostomy2026 Medicare rate & RVUs in Virginia
Percutaneous fixation secures an existing gastrostomy or cecostomy tube with a device when the tube needs stabilization rather than replacement.
In Virginia, Medicare pays $701.07 for 49460 in the office and $41.45 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 49460 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 49460 covers
This service uses a fixation device to secure an existing gastrostomy or cecostomy tube. It is distinct from placing a new feeding or drainage tube and from exchanging a tube that needs replacement. The procedure may be performed by an interventional radiologist or another physician who manages percutaneous access, typically in a procedural setting, when the tube needs mechanical stabilization.
Report the service when the physician performs the fixation, not merely when staff reinforce an external dressing or check tube position. Documentation should identify the existing tube, the reason fixation is needed, the device used, and the work performed. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed 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. Assistant-at-surgery payment requires documented medical necessity; 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 Virginia compares for 49460
Across 109 of 109 payment localities, the office rate for 49460 runs from $616.18 in Arkansas to $1,015.21 in San Benito County, CA. Virginia pays $701.07. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Virginia · this page$701.07
- Los Angeles, CA · California$837.86+$136.79
- Washington, DC area · District of Columbia$836.68+$135.61
- Miami, FL · Florida$747.72+$46.65
- Chicago, IL · Illinois$722.58+$21.51
- Manhattan, NY · New York$828.03+$126.96
- Alaska · Alaska$771.77+$70.70
Other areas in Virginia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $627.24 | $40.10 |
| ArkansasArkansas | $616.18 | $39.77 |
| ArizonaArizona | $692.17 | $41.95 |
| Bakersfield, CACalifornia | $777.93 | $42.49 |
| Chico, CACalifornia | $777.57 | $42.13 |
| El Centro, CACalifornia | $777.59 | $42.15 |
| Fresno, CACalifornia | $777.57 | $42.13 |
| Hanford, CACalifornia | $777.57 | $42.13 |
| Madera, CACalifornia | $777.57 | $42.13 |
| Merced, CACalifornia | $777.57 | $42.13 |
| Modesto, CACalifornia | $777.57 | $42.13 |
| Napa, CACalifornia | $929.51 | $45.10 |
| Oxnard, CACalifornia | $836.61 | $43.46 |
| Redding, CACalifornia | $777.57 | $42.13 |
| Rest of CaliforniaCalifornia | $777.57 | $42.13 |
| Riverside, CACalifornia | $778.88 | $43.43 |
| Sacramento, CACalifornia | $823.62 | $43.22 |
| Salinas, CACalifornia | $820.75 | $43.04 |
| San Diego, CACalifornia | $845.84 | $43.30 |
| Marin County, CACalifornia | $992.72 | $46.58 |
| San Francisco, CACalifornia | $992.59 | $46.44 |
| San Benito County, CACalifornia | $1,015.21 | $47.59 |
| Santa Clara County, CACalifornia | $1,014.65 | $47.04 |
| San Luis Obispo, CACalifornia | $806.74 | $42.45 |
| Santa Cruz, CACalifornia | $858.43 | $43.13 |
| Santa Maria, CACalifornia | $825.41 | $42.99 |
| Santa Rosa, CACalifornia | $867.53 | $43.51 |
| Stockton, CACalifornia | $777.57 | $42.13 |
| Vallejo, CACalifornia | $929.31 | $44.90 |
| Visalia, CACalifornia | $777.57 | $42.13 |
| Yuba City, CACalifornia | $777.57 | $42.13 |
| ColoradoColorado | $756.69 | $42.72 |
| ConnecticutConnecticut | $767.48 | $44.79 |
| DelawareDelaware | $705.39 | $42.42 |
| Fort Lauderdale, FLFlorida | $725.83 | $46.09 |
| Rest of FloridaFlorida | $685.94 | $44.45 |
| Atlanta, GAGeorgia | $725.53 | $43.77 |
| Rest of GeorgiaGeorgia | $641.28 | $42.73 |
| Hawaii, Guam, HIHawaii | $805.03 | $42.07 |
| IowaIowa | $653.70 | $39.71 |
| IdahoIdaho | $657.40 | $40.05 |
| East St. Louis, ILIllinois | $663.57 | $46.23 |
| Rest of IllinoisIllinois | $657.02 | $44.37 |
| Suburban Chicago, ILIllinois | $735.41 | $46.27 |
| IndianaIndiana | $662.20 | $40.16 |
| KansasKansas | $646.67 | $40.06 |
| KentuckyKentucky | $638.14 | $41.60 |
| New Orleans, LALouisiana | $674.30 | $42.86 |
| Rest of LouisianaLouisiana | $635.60 | $41.74 |
| Metropolitan Boston, MAMassachusetts | $846.23 | $45.03 |
| Rest of MassachusettsMassachusetts | $749.42 | $42.83 |
| Baltimore area, MDMaryland | $764.75 | $44.74 |
| Rest of MarylandMaryland | $721.90 | $42.83 |
| Rest of MaineMaine | $657.99 | $40.65 |
| Southern Maine, MEMaine | $706.19 | $41.21 |
| Detroit, MIMichigan | $692.78 | $45.25 |
| Rest of MichiganMichigan | $655.28 | $42.63 |
| MinnesotaMinnesota | $730.63 | $40.14 |
| Metropolitan Kansas City, MOMissouri | $672.30 | $42.21 |
| Metropolitan St. Louis, MOMissouri | $681.22 | $42.41 |
| Rest of MissouriMissouri | $620.06 | $41.63 |
| MississippiMississippi | $618.44 | $40.69 |
| MontanaMontana | $713.77 | $42.75 |
| North CarolinaNorth Carolina | $666.88 | $40.81 |
| North DakotaNorth Dakota | $711.40 | $40.37 |
| NebraskaNebraska | $659.05 | $39.69 |
| New HampshireNew Hampshire | $741.09 | $42.55 |
| Northern New JerseyNew Jersey | $824.57 | $46.18 |
| Rest of New JerseyNew Jersey | $777.83 | $45.07 |
| New MexicoNew Mexico | $658.28 | $42.95 |
| NevadaNevada | $713.79 | $42.09 |
| NYC suburbs and Long Island, NYNew York | $847.43 | $49.59 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $780.48 | $45.71 |
| Queens, NYNew York | $841.02 | $47.87 |
| Rest of New YorkNew York | $678.67 | $41.20 |
| OhioOhio | $654.79 | $42.15 |
| OklahomaOklahoma | $640.30 | $41.07 |
| Portland, OROregon | $788.55 | $43.05 |
| Rest of OregonOregon | $709.87 | $41.53 |
| Metropolitan Philadelphia, PAPennsylvania | $742.93 | $44.39 |
| Rest of PennsylvaniaPennsylvania | $657.93 | $41.93 |
| Puerto RicoPuerto Rico | $721.18 | $42.77 |
| Rhode IslandRhode Island | $736.33 | $43.16 |
| South CarolinaSouth Carolina | $661.62 | $41.59 |
| South DakotaSouth Dakota | $711.12 | $40.09 |
| TennesseeTennessee | $650.19 | $40.23 |
| Austin, TXTexas | $752.73 | $42.79 |
| Beaumont, TXTexas | $652.44 | $41.81 |
| Brazoria, TXTexas | $707.04 | $42.06 |
| Dallas, TXTexas | $710.78 | $42.44 |
| Fort Worth, TXTexas | $704.05 | $42.42 |
| Galveston, TXTexas | $708.59 | $42.26 |
| Houston, TXTexas | $710.79 | $44.46 |
| Rest of TexasTexas | $678.79 | $41.99 |
| UtahUtah | $672.67 | $41.90 |
| Virgin Islands, VIUnited States Virgin Islands | $721.18 | $42.77 |
| VermontVermont | $705.01 | $40.70 |
| Rest of WashingtonWashington | $749.18 | $42.59 |
| King County, WAWashington | $868.60 | $45.26 |
| WisconsinWisconsin | $682.51 | $39.67 |
| West VirginiaWest Virginia | $626.64 | $43.52 |
| WyomingWyoming | $712.74 | $41.71 |
49460 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.
$616.18
$896.39
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 | $771.77 | 1 |
| AL | $627.24 | 1 |
| AR | $616.18 | 1 |
| AZ | $692.17 | 1 |
| CA | $777.57–$1,015.21 | 29 |
| CO | $756.69 | 1 |
| CT | $767.48 | 1 |
| DC | $836.68 | 1 |
| DE | $705.39 | 1 |
| FL | $685.94–$747.72 | 3 |
| GA | $641.28–$725.53 | 2 |
| GU | $805.03 | 1 |
| HI | $805.03 | 1 |
| IA | $653.70 | 1 |
| ID | $657.40 | 1 |
| IL | $657.02–$735.41 | 4 |
| IN | $662.20 | 1 |
| KS | $646.67 | 1 |
| KY | $638.14 | 1 |
| LA | $635.60–$674.30 | 2 |
| MA | $749.42–$846.23 | 2 |
| MD | $721.90–$836.68 | 3 |
| ME | $657.99–$706.19 | 2 |
| MI | $655.28–$692.78 | 2 |
| MN | $730.63 | 1 |
| MO | $620.06–$681.22 | 3 |
| MS | $618.44 | 1 |
| MT | $713.77 | 1 |
| NC | $666.88 | 1 |
| ND | $711.40 | 1 |
| NE | $659.05 | 1 |
| NH | $741.09 | 1 |
| NJ | $777.83–$824.57 | 2 |
| NM | $658.28 | 1 |
| NV | $713.79 | 1 |
| NY | $678.67–$847.43 | 5 |
| OH | $654.79 | 1 |
| OK | $640.30 | 1 |
| OR | $709.87–$788.55 | 2 |
| PA | $657.93–$742.93 | 2 |
| PR | $721.18 | 1 |
| RI | $736.33 | 1 |
| SC | $661.62 | 1 |
| SD | $711.12 | 1 |
| TN | $650.19 | 1 |
| TX | $652.44–$752.73 | 8 |
| UT | $672.67 | 1 |
| VA | $701.07–$836.68 | 2 |
| VI | $721.18 | 1 |
| VT | $705.01 | 1 |
| WA | $749.18–$868.60 | 2 |
| WI | $682.51 | 1 |
| WV | $626.64 | 1 |
| WY | $712.74 | 1 |
How the 49460 rate is calculated
Each of 49460’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 · 49460
RVUs × geographic indexes × conversion factor
Work0.94
0.94 RVUs× 1.000 GPCI
Practice expense20.31
20.31 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
21.3700
Conversion factor
$33.4009
Medicare rate
$713.78
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Virginia inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,819
- Code
- 49460
- Physician work
- 0.94
- Practice expense
- 20.31
- Malpractice
- 0.12
GPCI2026.csv
106
- Locality
- Virginia
- Physician work
- 1.000
- Practice expense
- 0.983
- Malpractice
- 0.706
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.94 | × 1.000 | 0.9400 |
| Practice expense | 20.31 | × 0.983 | 19.9647 |
| Malpractice | 0.12 | × 0.706 | 0.0847 |
| Total RVUs | 20.9895 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Virginia$701.07
Office: (0.94 × 1 + 20.31 × 0.983 + 0.12 × 0.706) × $33.4009 = $701.07
Facility: (0.94 × 1 + 0.22 × 0.983 + 0.12 × 0.706) × $33.4009 = $41.45
Payment rules and modifiers for 49460
The CMS indicators that decide how 49460 is paid alongside other services.
CMS payment indicators · 49460
Tube fixation, gastrostomy or cecostomy
| 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
49460 without 51 · national office
$713.78
Tube fixation, gastrostomy or cecostomy
49460-51 · Second procedure: 50%
$356.89
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 49460 has changed in Virginia
49460 · Office / nonfacility
$701.07
Effective 2026-10-01
The base rate is $45.16 higher than on 2025-10-01, moving from $655.91 to $701.07 (6.9%).
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
$655.91changed to$701.07
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.96 changed to 0.94
- Practice expense RVU 19.53 changed to 20.31
- Malpractice RVU 0.13 changed to 0.12
- Work GPCI 1.002 changed to 1.000
- Practice expense GPCI 0.984 changed to 0.983
- Malpractice GPCI 0.755 changed to 0.706
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$706.11changed to$655.91
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 20.48 changed to 19.53
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$694.58changed to$706.11
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$713.90changed to$694.58
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 20.21 changed to 20.48
- Malpractice RVU 0.12 changed to 0.13
- Work GPCI 1.000 changed to 1.002
- Practice expense GPCI 0.990 changed to 0.984
- Malpractice GPCI 0.826 changed to 0.755
January 1, 2023
RVU23A
$716.00changed to$713.90
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 19.73 changed to 20.21
- Malpractice RVU 0.11 changed to 0.12
- Practice expense GPCI 0.995 changed to 0.990
- Malpractice GPCI 0.897 changed to 0.826
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$757.00changed to$716.00
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 20.74 changed to 19.73
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$743.87changed to$757.00
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 19.73 changed to 20.74
- Practice expense GPCI 0.991 changed to 0.995
- Malpractice GPCI 0.903 changed to 0.897
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$726.53changed to$743.87
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 19.38 changed to 19.73
- Malpractice RVU 0.10 changed to 0.11
- Practice expense GPCI 0.986 changed to 0.991
- Malpractice GPCI 0.908 changed to 0.903
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$744.90changed to$726.53
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 19.92 changed to 19.38
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$738.56changed to$744.90
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 19.83 changed to 19.92
- Practice expense GPCI 0.985 changed to 0.986
- Malpractice GPCI 0.866 changed to 0.908
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$736.31changed to$738.56
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 19.86 changed to 19.83
- Practice expense GPCI 0.983 changed to 0.985
- Malpractice GPCI 0.824 changed to 0.866
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$736.49changed to$736.31
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 19.79 changed to 19.86
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$732.83changed to$736.49
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$733.69changed to$732.83
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 19.84 changed to 19.79
- Practice expense GPCI 0.980 changed to 0.983
- Malpractice GPCI 0.778 changed to 0.824
Held through RVU15B.
January 1, 2014
RVU14A
$752.15changed to$733.69
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 21.57 changed to 19.84
- Practice expense GPCI 0.977 changed to 0.980
- Malpractice GPCI 0.731 changed to 0.778
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $752.15
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $701.07 | $41.45 | RVU26D |
| 2026-07-01 | $701.07 | $41.45 | RVU26C |
| 2026-04-01 | $701.07 | $41.45 | RVU26B |
| 2026-01-01 | $701.07 | $41.45 | RVU26A |
| 2025-10-01 | $655.91 | $47.34 | RVU25D |
| 2025-07-01 | $655.91 | $47.34 | RVU25C |
| 2025-04-01 | $655.91 | $47.34 | RVU25B |
| 2025-01-01 | $655.91 | $47.34 | RVU25A |
| 2024-10-01 | $706.11 | $48.39 | RVU24D |
| 2024-07-01 | $706.11 | $48.39 | RVU24C |
| 2024-04-01 | $706.11 | $48.39 | RVU24B |
| 2024-03-09 | $706.11 | $48.39 | RVU24AR |
| 2024-01-01 | $694.58 | $47.60 | RVU24A |
| 2023-10-01 | $713.90 | $48.64 | RVU23D |
| 2023-07-01 | $713.90 | $48.64 | RVU23C |
| 2023-04-01 | $713.90 | $48.64 | RVU23B |
| 2023-01-01 | $713.90 | $48.64 | RVU23A |
| 2022-10-01 | $716.00 | $48.69 | RVU22D |
| 2022-07-01 | $716.00 | $48.69 | RVU22C |
| 2022-04-01 | $716.00 | $48.69 | RVU22B |
| 2022-01-01 | $716.00 | $48.69 | RVU22A |
| 2021-10-01 | $757.00 | $49.09 | RVU21D |
| 2021-07-01 | $757.00 | $49.09 | RVU21C |
| 2021-04-01 | $757.00 | $49.09 | RVU21B |
| 2021-01-01 | $757.00 | $49.09 | RVU21A |
| 2020-10-01 | $743.87 | $50.39 | RVU20D |
| 2020-07-01 | $743.87 | $50.39 | RVU20C |
| 2020-04-01 | $743.87 | $50.39 | RVU20B |
| 2020-01-01 | $743.87 | $50.39 | RVU20A |
| 2019-10-01 | $726.53 | $49.60 | RVU19D |
| 2019-07-01 | $726.53 | $49.60 | RVU19C |
| 2019-04-01 | $726.53 | $49.60 | RVU19B |
| 2019-01-01 | $726.53 | $49.60 | RVU19A |
| 2018-10-01 | $744.90 | $49.54 | RVU18D |
| 2018-07-01 | $744.90 | $49.54 | RVU18C |
| 2018-04-01 | $744.90 | $49.54 | RVU18B |
| 2018-01-01 | $744.90 | $49.54 | RVU18AR1 |
| 2017-10-01 | $738.56 | $49.23 | RVU17D |
| 2017-07-01 | $738.56 | $49.23 | RVU17C |
| 2017-04-01 | $738.56 | $49.23 | RVU17B |
| 2017-01-01 | $738.56 | $49.23 | RVU17A |
| 2016-10-01 | $736.31 | $49.29 | RVU16D |
| 2016-07-01 | $736.31 | $49.29 | RVU16C |
| 2016-04-01 | $736.31 | $49.29 | RVU16B |
| 2016-01-01 | $736.31 | $49.29 | RVU16A |
| 2015-10-01 | $736.49 | $49.47 | RVU15D |
| 2015-07-01 | $736.49 | $49.47 | RVU15C |
| 2015-04-01 | $732.83 | $49.22 | RVU15B |
| 2015-01-01 | $732.83 | $49.22 | RVU15A |
| 2014-10-01 | $733.69 | $49.11 | RVU14D |
| 2014-07-01 | $733.69 | $49.11 | RVU14C |
| 2014-04-01 | $733.69 | $49.11 | RVU14B |
| 2014-01-01 | $733.69 | $49.11 | RVU14A |
| 2013-10-01 | $752.15 | $46.78 | RVU13D |
| 2013-07-01 | $752.15 | $46.78 | RVU13C |
| 2013-04-01 | $752.15 | $46.78 | RVU13B |
| 2013-01-01 | $752.15 | $46.78 | RVU13AR |
Where the Virginia rate applies
Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.
- Abbs Valley
- Abingdon
- Accomac
- Adwolf
- Afton
- Alberta
- Aldie
- Allison Gap
49460 billing questions
When should 49460 be used instead of 49450?
Use 49460 for fixation of an existing gastrostomy or cecostomy tube with a device. Use 49450 when the service is replacement of a gastrostomy or cecostomy tube.
Does 49460 include the fixation device?
The service is fixation with a device. The record should identify the device and document the fixation work performed.
Can modifier 50 be reported?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
Is same-day follow-up care separately payable?
No. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple-procedure 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
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