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CPT code 49465: Tube examination, fluoroscopic contrast study2026 Medicare rate & RVUs in Alabama

Fluoroscopic contrast evaluation checks the position and function of an indwelling gastric, intestinal, or colostomy tube when a tube problem is suspected.

CMS RVU26DEffective Oct 1, 2026One payment locality10K Medicare services in 2024

In Alabama, Medicare pays $115.57 for 49465 in the office and $24.39 when it’s performed in a hospital or facility.

$115.57Office (non-facility)
$24.39Hospital or facility
−11.1%vs the national office rate ($129.93)

Check a contract rate as a % of Medicare · 49465 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 49465 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Alabama
  2. What 49465 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 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.

How Alabama compares for 49465

Across 109 of 109 payment localities, the office rate for 49465 runs from $113.75 in Arkansas to $178.89 in San Benito County, CA. Alabama pays $115.57. The RVUs are the same everywhere; the geographic indexes change the dollars.

49465 in Alabama vs other payment areas
  1. Alabama · this page$115.57
  2. Los Angeles, CA · California$149.82+$34.25
  3. Washington, DC area · District of Columbia$150.44+$34.87
  4. Miami, FL · Florida$137.42+$21.85
  5. Chicago, IL · Illinois$133.20+$17.63
  6. Manhattan, NY · New York$149.86+$34.29
  7. Alaska · Alaska$146.06+$30.49

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

Every other payment area

49465 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$113.75$24.23
ArizonaArizona$126.30$25.32
Bakersfield, CACalifornia$139.88$25.67
Chico, CACalifornia$139.70$25.48
El Centro, CACalifornia$139.71$25.49
Fresno, CACalifornia$139.70$25.48
Hanford, CACalifornia$139.70$25.48
Madera, CACalifornia$139.70$25.48

49465 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.

$113.75

$159.30

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

View every state and territory as a table
49465 office rate range by state
State / territoryOffice rate rangeLocalities
AK$146.061
AL$115.571
AR$113.751
AZ$126.301
CA$139.70–$178.8929
CO$136.641
CT$139.061
DC$150.441
DE$128.531
FL$126.19–$137.423
GA$118.66–$132.122
GU$143.871
HI$143.871
IA$119.551
ID$120.241
IL$121.67–$134.534
IN$121.021
KS$118.581
KY$117.781
LA$117.44–$123.842
MA$135.56–$151.462
MD$131.26–$150.443
ME$120.54–$128.222
MI$120.80–$127.532
MN$131.651
MO$114.99–$124.763
MS$114.411
MT$129.931
NC$121.981
ND$128.741
NE$120.381
NH$134.101
NJ$140.85–$148.592
NM$121.381
NV$129.701
NY$123.94–$153.325
OH$120.561
OK$117.941
OR$128.90–$141.712
PA$120.97–$135.102
PR$131.091
RI$133.651
SC$121.431
SD$128.601
TN$119.181
TX$120.08–$136.008
UT$123.251
VA$127.51–$150.442
VI$131.091
VT$127.861
WA$135.43–$155.052
WI$124.011
WV$116.661
WY$129.411

See 49465 in every payment locality

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

Office or facility?

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.

The exact Alabama inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,820

Code
49465
Physician work
0.60
Practice expense
3.23
Malpractice
0.06

GPCI2026.csv

4

Locality
Alabama
Physician work
1.000
Practice expense
0.875
Malpractice
0.566
Office calculation for 49465 in Alabama
ComponentRVULocality factorAdjusted
Physician work0.60× 1.0000.6000
Practice expense3.23× 0.8752.8262
Malpractice0.06× 0.5660.0340
Total RVUs3.4602
Conversion factor× 33.4009

Office rate, Alabama$115.57

Office: (0.6 × 1 + 3.23 × 0.875 + 0.06 × 0.566) × $33.4009 = $115.57

Facility: (0.6 × 1 + 0.11 × 0.875 + 0.06 × 0.566) × $33.4009 = $24.39

Open 49465 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 49465

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

Codes related to 49465
CodeHow it relatesOffice range, Alabama
Used instead
49460Tube fixation, gastrostomy or cecostomyUsed when the service repositions a gastrostomy or cecostomy tube rather than examining it diagnostically.$627.24
49450Feeding tube replacement, gastrostomy or cecostomyReports percutaneous replacement of a gastrostomy or cecostomy tube, not a contrast examination alone.$497.63
49451Feeding tube exchange, duodenal or jejunal tubeReports percutaneous replacement of a duodenostomy or jejunostomy tube.$531.95
49452G-J tube replacement, percutaneous exchangeReports percutaneous replacement of a gastrojejunostomy tube.$645.09

How 49465 has changed in Alabama

49465 · Office / nonfacility

$115.57

Effective 2026-10-01

The base rate is $0.98 higher than on 2025-10-01, moving from $114.59 to $115.57 (0.9%).

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

    $114.59changed to$115.57

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.62 changed to 0.60
    • Practice expense RVU 3.33 changed to 3.23
    • Malpractice RVU 0.05 changed to 0.06
    • Practice expense GPCI 0.869 changed to 0.875
    • Malpractice GPCI 0.575 changed to 0.566

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $119.85changed to$114.59

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.39 changed to 3.33
    • Malpractice RVU 0.06 changed to 0.05

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $117.89changed to$119.85

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $124.58changed to$117.89

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.43 changed to 3.39
    • Practice expense GPCI 0.878 changed to 0.869
    • Malpractice GPCI 0.748 changed to 0.575

  5. January 1, 2023

    RVU23A

    $128.45changed to$124.58

    • Conversion factor 34.6062 changed to 33.8872
    • Malpractice RVU 0.05 changed to 0.06
    • Practice expense GPCI 0.888 changed to 0.878
    • Malpractice GPCI 0.921 changed to 0.748

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $137.58changed to$128.45

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.69 changed to 3.43

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $141.40changed to$137.58

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.67 changed to 3.69
    • Practice expense GPCI 0.889 changed to 0.888
    • Malpractice GPCI 0.707 changed to 0.921

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $145.44changed to$141.40

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.81 changed to 3.67
    • Practice expense GPCI 0.890 changed to 0.889
    • Malpractice GPCI 0.492 changed to 0.707

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $151.04changed to$145.44

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.99 changed to 3.81

    Held through RVU19B, RVU19C, RVU19D.

  10. April 1, 2018

    RVU18B

    No ratechanged to$151.04

    Held through RVU18C, RVU18D.

  11. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$115.57$24.39RVU26D
2026-07-01$115.57$24.39RVU26C
2026-04-01$115.57$24.39RVU26B
2026-01-01$115.57$24.39RVU26A
2025-10-01$114.59$27.17RVU25D
2025-07-01$114.59$27.17RVU25C
2025-04-01$114.59$27.17RVU25B
2025-01-01$114.59$27.17RVU25A
2024-10-01$119.85$27.86RVU24D
2024-07-01$119.85$27.86RVU24C
2024-04-01$119.85$27.86RVU24B
2024-03-09$119.85$27.86RVU24AR
2024-01-01$117.89$27.41RVU24A
2023-10-01$124.58$29.08RVU23D
2023-07-01$124.58$29.08RVU23C
2023-04-01$124.58$29.08RVU23B
2023-01-01$124.58$29.08RVU23A
2022-10-01$128.45$29.50RVU22D
2022-07-01$128.45$29.50RVU22C
2022-04-01$128.45$29.50RVU22B
2022-01-01$128.45$29.50RVU22A
2021-10-01$137.58$30.06RVU21D
2021-07-01$137.58$30.06RVU21C
2021-04-01$137.58$30.06RVU21B
2021-01-01$137.58$30.06RVU21A
2020-10-01$141.40$30.71RVU20D
2020-07-01$141.40$30.71RVU20C
2020-04-01$141.40$30.71RVU20B
2020-01-01$141.40$30.71RVU20A
2019-10-01$145.44$30.29RVU19D
2019-07-01$145.44$30.29RVU19C
2019-04-01$145.44$30.29RVU19B
2019-01-01$145.44$30.29RVU19A
2018-10-01$151.04$30.25RVU18D
2018-07-01$151.04$30.25RVU18C
2018-04-01$151.04$30.25RVU18B
2018-01-01Rate data unavailableRate data unavailableRVU18AR1
2017-10-01Rate data unavailableRate data unavailableRVU17D
2017-07-01Rate data unavailableRate data unavailableRVU17C
2017-04-01Rate data unavailableRate data unavailableRVU17B
2017-01-01Rate data unavailableRate data unavailableRVU17A
2016-10-01Rate data unavailableRate data unavailableRVU16D
2016-07-01Rate data unavailableRate data unavailableRVU16C
2016-04-01Rate data unavailableRate data unavailableRVU16B
2016-01-01Rate data unavailableRate data unavailableRVU16A
2015-10-01Rate data unavailableRate data unavailableRVU15D
2015-07-01Rate data unavailableRate data unavailableRVU15C
2015-04-01Rate data unavailableRate data unavailableRVU15B
2015-01-01Rate data unavailableRate data unavailableRVU15A
2014-10-01Rate data unavailableRate data unavailableRVU14D
2014-07-01Rate data unavailableRate data unavailableRVU14C
2014-04-01Rate data unavailableRate data unavailableRVU14B
2014-01-01Rate data unavailableRate data unavailableRVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 49465 for an earlier date of service

Where the Alabama rate applies

Alabama is a Medicare payment area, not a city. Our Census mapping connects it to 595 cities and communities in Alabama. Some span more than one payment area; confirm with the service ZIP.

  • Abanda
  • Abbeville
  • Adamsville
  • Addison
  • Akron
  • Alabaster
  • Albertville
  • Alexander City

Browse all communities in Alabama

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
RVUs for 49465PPRRVU2026_Oct_nonQPP.csv, line 5,820 (RVU26D)
Geographic factors for AlabamaGPCI2026.csv, line 4 (RVU26D)

Open CMS sourceHow we calculate rates

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