CPT code 49465: Tube examination, fluoroscopic contrast study2026 Medicare rate & RVUs
Fluoroscopic contrast evaluation checks the position and function of an indwelling gastric, intestinal, or colostomy tube when a tube problem is suspected.
Medicare pays $129.93 for 49465 nationally in the office and $25.72 in a hospital or facility. Local office rates run $113.75–$178.89.
Medicare rate · 49465
Tube examination, fluoroscopic contrast study
- Work RVUs
- 0.6
- Total RVUs
- 3.89
- Global days
- 000
National rate · 2026
$129.93
Office setting, before claim adjustments.
See every locality for 49465 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 10 sections
What 49465 covers
A physician, commonly a radiologist, evaluates an indwelling gastrostomy, duodenostomy, jejunostomy, gastrojejunostomy, or colostomy tube by injecting contrast through it and observing the flow under fluoroscopy. The study can help assess tube position, patency, or suspected leakage. It is performed in a radiology department or another setting equipped for fluoroscopic imaging when the clinical question calls for a contrast examination of the existing tube.
Report 49465 for the fluoroscopic examination, including the contrast injection or injections, image documentation, and report. The record should identify the tube examined, the reason for the study, the contrast findings, and the interpretation. This is a diagnostic examination, not a tube replacement or repositioning service. It has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same 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.
Where 49465 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$113.75 to $178.89
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $115.57 | $24.39 |
| Alaska | $146.06 | $35.08 |
| Arizona | $126.30 | $25.32 |
| Arkansas | $113.75 | $24.23 |
| Atlanta, GA | $132.12 | $26.24 |
| Austin, TX | $136.00 | $25.74 |
| Bakersfield, CA | $139.88 | $25.67 |
| Baltimore area, MD | $138.60 | $26.78 |
| Beaumont, TX | $120.08 | $25.25 |
| Brazoria, TX | $128.68 | $25.41 |
| Chicago, IL | $133.20 | $28.47 |
| Chico, CA | $139.70 | $25.48 |
| Colorado | $136.64 | $25.76 |
| Connecticut | $139.06 | $26.82 |
| Dallas, TX | $129.39 | $25.60 |
| Delaware | $128.53 | $25.57 |
| Detroit, MI | $127.53 | $26.96 |
| East St. Louis, IL | $123.33 | $27.46 |
| El Centro, CA | $139.71 | $25.49 |
| Fort Lauderdale, FL | $132.95 | $27.39 |
| Fort Worth, TX | $128.34 | $25.59 |
| Fresno, CA | $139.70 | $25.48 |
| Galveston, TX | $128.99 | $25.51 |
| Hanford, CA | $139.70 | $25.48 |
| Hawaii, Guam, HI | $143.87 | $25.38 |
| Houston, TX | $130.09 | $26.61 |
| Idaho | $120.24 | $24.37 |
| Indiana | $121.02 | $24.42 |
| Iowa | $119.55 | $24.20 |
| Kansas | $118.58 | $24.37 |
| Kentucky | $117.78 | $25.14 |
| King County, WA | $155.05 | $27.19 |
| Los Angeles, CA | $149.82 | $26.54 |
| Madera, CA | $139.70 | $25.48 |
| Manhattan, NY | $149.86 | $28.77 |
| Marin County, CA | $174.98 | $28.04 |
| Merced, CA | $139.70 | $25.48 |
| Metropolitan Boston, MA | $151.46 | $27.03 |
| Metropolitan Kansas City, MO | $123.30 | $25.45 |
| Metropolitan Philadelphia, PA | $135.10 | $26.62 |
| Metropolitan St. Louis, MO | $124.76 | $25.55 |
| Miami, FL | $137.42 | $28.93 |
| Minnesota | $131.65 | $24.41 |
| Mississippi | $114.41 | $24.68 |
| Modesto, CA | $139.70 | $25.48 |
| Montana | $129.93 | $25.71 |
| Napa, CA | $164.51 | $27.16 |
| Nebraska | $120.38 | $24.19 |
| Nevada | $129.70 | $25.39 |
| New Hampshire | $134.10 | $25.62 |
| New Mexico | $121.38 | $25.82 |
| New Orleans, LA | $123.84 | $25.77 |
| North Carolina | $121.98 | $24.75 |
| North Dakota | $128.74 | $24.53 |
| Northern New Jersey | $148.59 | $27.71 |
| NYC suburbs and Long Island, NY | $153.32 | $29.41 |
| Ohio | $120.56 | $25.42 |
| Oklahoma | $117.94 | $24.88 |
| Oxnard, CA | $149.37 | $26.19 |
| Portland, OR | $141.71 | $25.93 |
| Poughkeepsie and northern NYC suburbs, NY | $141.50 | $27.39 |
| Puerto Rico | $131.09 | $25.73 |
| Queens, NY | $151.73 | $28.56 |
| Redding, CA | $139.70 | $25.48 |
| Rest of California | $139.70 | $25.48 |
| Rest of Florida | $126.19 | $26.57 |
| Rest of Georgia | $118.66 | $25.71 |
| Rest of Illinois | $121.67 | $26.53 |
| Rest of Louisiana | $117.44 | $25.21 |
| Rest of Maine | $120.54 | $24.67 |
| Rest of Maryland | $131.26 | $25.80 |
| Rest of Massachusetts | $135.56 | $25.83 |
| Rest of Michigan | $120.80 | $25.66 |
| Rest of Missouri | $114.99 | $25.16 |
| Rest of New Jersey | $140.85 | $27.05 |
| Rest of New York | $123.94 | $24.94 |
| Rest of Oregon | $128.90 | $25.11 |
| Rest of Pennsylvania | $120.97 | $25.31 |
| Rest of Texas | $124.23 | $25.34 |
| Rest of Washington | $135.43 | $25.69 |
| Rhode Island | $133.65 | $26.00 |
| Riverside, CA | $140.35 | $26.14 |
| Sacramento, CA | $147.31 | $26.11 |
| Salinas, CA | $146.77 | $25.99 |
| San Benito County, CA | $178.89 | $28.62 |
| San Diego, CA | $150.76 | $26.12 |
| San Francisco, CA | $174.91 | $27.98 |
| San Luis Obispo, CA | $144.34 | $25.64 |
| Santa Clara County, CA | $178.61 | $28.34 |
| Santa Cruz, CA | $152.62 | $26.00 |
| Santa Maria, CA | $147.47 | $25.96 |
| Santa Rosa, CA | $154.20 | $26.23 |
| South Carolina | $121.43 | $25.14 |
| South Dakota | $128.60 | $24.39 |
| Southern Maine, ME | $128.22 | $24.95 |
| Stockton, CA | $139.70 | $25.48 |
| Suburban Chicago, IL | $134.53 | $27.51 |
| Tennessee | $119.18 | $24.46 |
| Utah | $123.25 | $25.29 |
| Vallejo, CA | $164.42 | $27.07 |
| Vermont | $127.86 | $24.69 |
| Virgin Islands, VI | $131.09 | $25.73 |
| Virginia | $127.51 | $25.07 |
| Visalia, CA | $139.70 | $25.48 |
| Washington, DC area | $150.44 | $27.68 |
| West Virginia | $116.66 | $26.10 |
| Wisconsin | $124.01 | $24.18 |
| Wyoming | $129.41 | $25.20 |
| Yuba City, CA | $139.70 | $25.48 |
49465 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.
$113.75
$159.30
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 | $146.06 | 1 |
| AL | $115.57 | 1 |
| AR | $113.75 | 1 |
| AZ | $126.30 | 1 |
| CA | $139.70–$178.89 | 29 |
| CO | $136.64 | 1 |
| CT | $139.06 | 1 |
| DC | $150.44 | 1 |
| DE | $128.53 | 1 |
| FL | $126.19–$137.42 | 3 |
| GA | $118.66–$132.12 | 2 |
| GU | $143.87 | 1 |
| HI | $143.87 | 1 |
| IA | $119.55 | 1 |
| ID | $120.24 | 1 |
| IL | $121.67–$134.53 | 4 |
| IN | $121.02 | 1 |
| KS | $118.58 | 1 |
| KY | $117.78 | 1 |
| LA | $117.44–$123.84 | 2 |
| MA | $135.56–$151.46 | 2 |
| MD | $131.26–$150.44 | 3 |
| ME | $120.54–$128.22 | 2 |
| MI | $120.80–$127.53 | 2 |
| MN | $131.65 | 1 |
| MO | $114.99–$124.76 | 3 |
| MS | $114.41 | 1 |
| MT | $129.93 | 1 |
| NC | $121.98 | 1 |
| ND | $128.74 | 1 |
| NE | $120.38 | 1 |
| NH | $134.10 | 1 |
| NJ | $140.85–$148.59 | 2 |
| NM | $121.38 | 1 |
| NV | $129.70 | 1 |
| NY | $123.94–$153.32 | 5 |
| OH | $120.56 | 1 |
| OK | $117.94 | 1 |
| OR | $128.90–$141.71 | 2 |
| PA | $120.97–$135.10 | 2 |
| PR | $131.09 | 1 |
| RI | $133.65 | 1 |
| SC | $121.43 | 1 |
| SD | $128.60 | 1 |
| TN | $119.18 | 1 |
| TX | $120.08–$136.00 | 8 |
| UT | $123.25 | 1 |
| VA | $127.51–$150.44 | 2 |
| VI | $131.09 | 1 |
| VT | $127.86 | 1 |
| WA | $135.43–$155.05 | 2 |
| WI | $124.01 | 1 |
| WV | $116.66 | 1 |
| WY | $129.41 | 1 |
How the 49465 rate is calculated
Each of 49465’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 · 49465
RVUs × geographic indexes × conversion factor
Work0.60
0.60 RVUs× 1.000 GPCI
Practice expense3.23
3.23 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
3.8900
Conversion factor
$33.4009
Medicare rate
$129.93
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49465
The CMS indicators that decide how 49465 is paid alongside other services.
CMS payment indicators · 49465
Tube examination, fluoroscopic contrast study
| 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
49465 without 51 · national office
$129.93
Tube examination, fluoroscopic contrast study
49465-51 · Second procedure: 50%
$64.97
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%).
49465 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49460Tube fixationGastrostomy or cecostomy
- 49465 evaluates an existing tube with fluoroscopic contrast. 49460 is for repositioning a gastrostomy or cecostomy tube.
- 49450Feeding tube replacementGastrostomy or cecostomy
- 49465 is a diagnostic contrast examination; 49450 reports percutaneous replacement of a gastrostomy or cecostomy tube.
- 49452G-J tube replacementPercutaneous exchange
- Use 49465 for fluoroscopic examination of an existing gastrojejunostomy tube; use 49452 when that tube is replaced percutaneously.
49465 billing questions
When should 49465 be selected instead of a tube replacement code?
Use 49465 when the service is a fluoroscopic contrast examination of the existing tube. Use a replacement code when the tube is actually exchanged.
Are contrast injection and image documentation separately reported?
They are included in 49465 along with the fluoroscopic examination and report.
Can modifier 50 be used for tubes on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports reporting 49465?
Document the tube examined, the clinical reason for the study, contrast administration, fluoroscopic findings, and the interpretation.
How does the multiple-procedure reduction affect 49465?
When it is performed in the same session as other procedures, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted.
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
Fee sheets · Coming soon
Put 49465 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist