Billing code 49446: Tube conversionMedicare rate & RVUs
Reports fluoroscopic conversion of an established gastrostomy into gastrojejunal access when post-pyloric tube delivery is needed through the existing tract.
Medicare pays $763.54 for 49446 nationally in the office and $126.26 in a hospital or facility. Local office rates run $665.90–$1,057.39.
Medicare rate · 49446
Tube conversion
Swap in your local Medicare rate.
- Work RVUs
- 2.98
- Total RVUs
- 22.86
- Global days
- 000
National rate · 2026
$763.54
Office setting, before claim adjustments.
See every locality for 49446 → · 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.
On this page 10 sections
What 49446 covers
This service converts an established percutaneous gastrostomy access into gastrojejunal access by passing a tube through the existing gastric tract and positioning its distal end in the small bowel under fluoroscopic guidance. It is typically performed by an interventional radiologist when post-pyloric delivery is needed, including when gastric feeding is not tolerated. Contrast injection and fluoroscopic confirmation of tube position are part of the documented procedure.
Report 49446 for conversion, rather than simply exchanging a G-J tube or replacing a G-tube with another gastric tube. Documentation should identify the existing gastrostomy, the conversion performed, relevant imaging or contrast findings, and the final tube position. The 0-day global period includes same-day preoperative and postoperative care. When another procedure in the same session is subject to the multiple procedure rule, the highest-valued procedure is paid in full and the others at 50%. 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 49446 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
$665.90 to $1057.39
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $676.93 | $119.30 |
| Alaska* | $850.46 | $171.75 |
| Arizona | $741.64 | $124.11 |
| Arkansas | $665.90 | $118.47 |
| Atlanta | $776.63 | $129.14 |
| Austin | $800.25 | $125.99 |
| Bakersfield | $823.49 | $125.02 |
| Baltimore/Surr. Cntys | $815.53 | $131.72 |
| Beaumont | $704.01 | $124.07 |
| Brazoria | $755.90 | $124.34 |
| Chicago | $782.64 | $142.17 |
| Chico | $822.44 | $123.97 |
| Colorado | $803.93 | $125.85 |
| Connecticut | $818.22 | $131.86 |
| Dallas | $760.17 | $125.43 |
| Dc + Md/Va Suburbs | $886.35 | $135.63 |
| Delaware | $755.03 | $125.39 |
| Detroit | $748.73 | $133.75 |
| East St. Louis | $723.21 | $136.91 |
| El Centro | $822.49 | $124.02 |
| Fort Lauderdale | $781.47 | $135.90 |
| Fort Worth | $753.80 | $125.43 |
| Fresno | $822.44 | $123.97 |
| Galveston | $757.76 | $124.94 |
| Hanford-Corcoran | $822.44 | $123.97 |
| Hawaii, Guam | $847.99 | $123.39 |
| Houston | $764.17 | $131.34 |
| Idaho | $705.20 | $118.89 |
| Indiana | $709.92 | $119.15 |
| Iowa | $701.05 | $117.93 |
| Kansas | $695.12 | $119.01 |
| Kentucky | $690.14 | $123.59 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $883.07 | $129.16 |
| Madera | $822.44 | $123.97 |
| Manhattan | $882.44 | $141.91 |
| Merced | $822.44 | $123.97 |
| Metropolitan Boston | $892.89 | $131.97 |
| Metropolitan Kansas City | $723.48 | $125.07 |
| Metropolitan Philadelphia | $794.34 | $130.92 |
| Metropolitan St. Louis | $732.26 | $125.56 |
| Miami | $808.16 | $144.75 |
| Minnesota | $774.23 | $118.46 |
| Mississippi | $669.82 | $121.12 |
| Modesto | $822.44 | $123.97 |
| Montana** | $763.52 | $126.23 |
| Napa | $971.50 | $131.55 |
| Nebraska | $706.04 | $117.83 |
| Nevada** | $762.24 | $124.32 |
| New Hampshire | $788.83 | $125.41 |
| New Mexico | $711.75 | $127.36 |
| New Orleans | $726.65 | $126.96 |
| North Carolina | $715.62 | $121.03 |
| North Dakota** | $756.60 | $119.31 |
| Northern Nj | $874.98 | $135.73 |
| Nyc Suburbs/Long Island | $903.22 | $145.48 |
| Ohio | $706.89 | $125.04 |
| Oklahoma | $691.14 | $122.04 |
| Oxnard-Thousand Oaks-Ventura | $880.65 | $127.37 |
| Portland | $834.55 | $126.52 |
| Poughkpsie/N Nyc Suburbs | $832.45 | $134.62 |
| Puerto Rico | $770.54 | $126.25 |
| Queens | $893.80 | $140.53 |
| Redding | $822.44 | $123.97 |
| Rest Of California | $822.44 | $123.97 |
| Rest Of Florida | $740.72 | $131.47 |
| Rest Of Georgia | $695.34 | $126.88 |
| Rest Of Illinois | $713.37 | $131.53 |
| Rest Of Louisiana | $688.04 | $124.04 |
| Rest Of Maine | $706.94 | $120.63 |
| Rest Of Maryland | $771.41 | $126.47 |
| Rest Of Massachusetts | $797.34 | $126.27 |
| Rest Of Michigan | $708.30 | $126.46 |
| Rest Of Missouri | $673.22 | $123.88 |
| Rest Of New Jersey | $828.67 | $132.75 |
| Rest Of New York | $727.46 | $122.03 |
| Rest Of Oregon | $757.46 | $122.72 |
| Rest Of Pennsylvania | $709.41 | $124.38 |
| Rest Of Texas | $729.14 | $124.35 |
| Rest Of Washington | $796.62 | $125.55 |
| Rhode Island | $785.70 | $127.38 |
| Riverside-San Bernardino-Ontario | $826.24 | $127.77 |
| Sacramento-Roseville-Folsom | $868.03 | $126.86 |
| Salinas | $864.92 | $126.31 |
| San Diego-Chula Vista-Carlsbad | $889.03 | $126.83 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $1,034.13 | $135.55 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $1,033.73 | $135.15 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $1,057.39 | $138.42 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $1,055.77 | $136.80 |
| San Luis Obispo-Paso Robles | $850.48 | $124.61 |
| Santa Cruz-Watsonville | $900.46 | $126.15 |
| Santa Maria-Santa Barbara | $869.19 | $126.11 |
| Santa Rosa-Petaluma | $909.84 | $127.24 |
| Seattle (King Cnty) | $914.46 | $132.50 |
| South Carolina | $712.21 | $123.36 |
| South Dakota** | $755.78 | $118.49 |
| Southern Maine | $753.36 | $121.81 |
| Stockton | $822.44 | $123.97 |
| Suburban Chicago | $790.88 | $136.38 |
| Tennessee | $698.77 | $119.48 |
| Utah | $723.21 | $124.16 |
| Vallejo | $970.93 | $130.98 |
| Vermont | $751.25 | $120.33 |
| Virgin Islands | $770.54 | $126.25 |
| Virginia | $749.02 | $122.56 |
| Visalia | $822.44 | $123.97 |
| West Virginia | $683.13 | $129.32 |
| Wisconsin | $728.06 | $117.53 |
| Wyoming** | $760.51 | $123.22 |
| Yuba City | $822.44 | $123.97 |
49446 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.
$665.90
$939.92
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 | $850.46 | 1 |
| AL | $676.93 | 1 |
| AR | $665.90 | 1 |
| AZ | $741.64 | 1 |
| CA | $822.44–$1,057.39 | 29 |
| CO | $803.93 | 1 |
| CT | $818.22 | 1 |
| DC | $886.35 | 1 |
| DE | $755.03 | 1 |
| FL | $740.72–$808.16 | 3 |
| GA | $695.34–$776.63 | 2 |
| GU | $847.99 | 1 |
| HI | $847.99 | 1 |
| IA | $701.05 | 1 |
| ID | $705.20 | 1 |
| IL | $713.37–$790.88 | 4 |
| IN | $709.92 | 1 |
| KS | $695.12 | 1 |
| KY | $690.14 | 1 |
| LA | $688.04–$726.65 | 2 |
| MA | $797.34–$892.89 | 2 |
| MD | $771.41–$886.35 | 3 |
| ME | $706.94–$753.36 | 2 |
| MI | $708.30–$748.73 | 2 |
| MN | $774.23 | 1 |
| MO | $673.22–$732.26 | 3 |
| MS | $669.82 | 1 |
| MT | $763.52 | 1 |
| NC | $715.62 | 1 |
| ND | $756.60 | 1 |
| NE | $706.04 | 1 |
| NH | $788.83 | 1 |
| NJ | $828.67–$874.98 | 2 |
| NM | $711.75 | 1 |
| NV | $762.24 | 1 |
| NY | $727.46–$903.22 | 5 |
| OH | $706.89 | 1 |
| OK | $691.14 | 1 |
| OR | $757.46–$834.55 | 2 |
| PA | $709.41–$794.34 | 2 |
| PR | $770.54 | 1 |
| RI | $785.70 | 1 |
| SC | $712.21 | 1 |
| SD | $755.78 | 1 |
| TN | $698.77 | 1 |
| TX | $704.01–$800.25 | 8 |
| UT | $723.21 | 1 |
| VA | $749.02–$886.35 | 2 |
| VI | $770.54 | 1 |
| VT | $751.25 | 1 |
| WA | $796.62–$914.46 | 2 |
| WI | $728.06 | 1 |
| WV | $683.13 | 1 |
| WY | $760.51 | 1 |
How the 49446 rate is calculated
Each of 49446’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 · 49446
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.98Practice expense 19.53Malpractice 0.35
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49446
The CMS indicators that decide how 49446 is paid alongside other services.
CMS payment indicators · 49446
Tube conversion
| 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
49446 without 51 · national office
$763.54
Tube conversion
49446-51 · Second procedure: 50%
$381.77
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%).
49446 compared with similar codes
Compare codes
49446 vs 49452 vs 49450 vs 49440: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49452G-J tube replacement
- 49446 converts an existing gastrostomy to G-J access. 49452 is for replacing an existing G-J tube.
- 49450Feeding tube replacement
- 49450 replaces a gastrostomy tube while maintaining gastric access; 49446 changes the access to gastrojejunal delivery.
- 49440Gastrostomy placement
- 49440 places new percutaneous gastrostomy access. 49446 converts an established gastrostomy route to G-J access.
49446 billing questions
When should I report 49446 instead of 49452?
Use 49446 to convert an existing gastrostomy to gastrojejunal access. Use 49452 when replacing an existing G-J tube.
Can fluoroscopy or contrast be billed separately?
Fluoroscopic guidance, contrast injection, image documentation, and the report are included in the conversion service.
Should modifier 50 be appended?
No. Bilateral adjustment is inappropriate for this service. The CMS multiple procedure reduction may apply when other procedures are performed in the same session.
What documentation supports reporting 49446?
Document the existing gastrostomy access, the conversion to gastrojejunal access, imaging or contrast findings, and the final tube position.
Can an assistant surgeon be paid for this procedure?
Assistant-at-surgery payment is permitted only when medical necessity is documented. 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
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