Billing code 49450: Feeding tube replacementMedicare rate & RVUs
Report this service when a clinician replaces an existing gastrostomy or cecostomy tube percutaneously using fluoroscopic guidance and contrast assessment.
Medicare pays $564.14 for 49450 nationally in the office and $56.45 in a hospital or facility. Local office rates run $489.14–$794.20.
Medicare rate · 49450
Feeding tube replacement
Swap in your local Medicare rate.
- Work RVUs
- 1.33
- Total RVUs
- 16.89
- Global days
- 000
National rate · 2026
$564.14
Office setting, before claim adjustments.
See every locality for 49450 → · 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 49450 covers
This service covers percutaneous replacement of an existing gastrostomy or cecostomy tube, with fluoroscopic guidance and contrast assessment to confirm tube position and function. It is commonly performed by an interventional radiologist in an imaging suite when a tube is dislodged, malfunctioning, or due for exchange. It is a replacement through an established tract, not creation of a new gastrostomy or cecostomy tract.
Report the code when documentation supports replacement of the existing tube and the imaging work associated with the exchange. The 0-day global includes same-day preoperative and postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. 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 49450 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
$489.14 to $794.20
109 of 109 payment localities
49450 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$489.14
$703.09
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 | $617.56 | 1 |
| AL | $497.63 | 1 |
| AR | $489.14 | 1 |
| AZ | $547.46 | 1 |
| CA | $611.98–$794.20 | 29 |
| CO | $596.52 | 1 |
| CT | $605.71 | 1 |
| DC | $658.72 | 1 |
| DE | $557.68 | 1 |
| FL | $544.01–$592.90 | 3 |
| GA | $509.51–$573.52 | 2 |
| GU | $632.55 | 1 |
| HI | $632.55 | 1 |
| IA | $517.37 | 1 |
| ID | $520.32 | 1 |
| IL | $522.18–$582.22 | 4 |
| IN | $523.99 | 1 |
| KS | $512.24 | 1 |
| KY | $506.58 | 1 |
| LA | $504.74–$534.45 | 2 |
| MA | $591.11–$665.26 | 2 |
| MD | $570.35–$658.72 | 3 |
| ME | $521.07–$557.66 | 2 |
| MI | $520.01–$549.56 | 2 |
| MN | $575.54 | 1 |
| MO | $492.98–$539.45 | 3 |
| MS | $491.29 | 1 |
| MT | $564.13 | 1 |
| NC | $527.85 | 1 |
| ND | $561.17 | 1 |
| NE | $521.39 | 1 |
| NH | $584.62 | 1 |
| NJ | $613.76–$649.63 | 2 |
| NM | $522.43 | 1 |
| NV | $563.82 | 1 |
| NY | $536.92–$668.56 | 5 |
| OH | $519.40 | 1 |
| OK | $507.95 | 1 |
| OR | $560.59–$620.70 | 2 |
| PA | $521.66–$587.01 | 2 |
| PR | $569.73 | 1 |
| RI | $581.43 | 1 |
| SC | $524.27 | 1 |
| SD | $560.81 | 1 |
| TN | $514.98 | 1 |
| TX | $517.46–$593.51 | 8 |
| UT | $532.75 | 1 |
| VA | $553.92–$658.72 | 2 |
| VI | $569.73 | 1 |
| VT | $556.52 | 1 |
| WA | $590.80–$682.28 | 2 |
| WI | $539.06 | 1 |
| WV | $498.87 | 1 |
| WY | $562.84 | 1 |
How the 49450 rate is calculated
Each of 49450’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 · 49450
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.33Practice expense 15.41Malpractice 0.15
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49450
The CMS indicators that decide how 49450 is paid alongside other services.
CMS payment indicators · 49450
Feeding tube replacement
| 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
49450 without 51 · national office
$564.14
Feeding tube replacement
49450-51 · Second procedure: 50%
$282.07
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%).
49450 compared with similar codes
Compare codes
49450 vs 49451 vs 49452 vs 43762 vs 49465: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49451Feeding tube exchange
- Use 49451 for a percutaneous duodenostomy or jejunostomy tube exchange; 49450 is for a gastrostomy or cecostomy tube.
- 49452G-J tube replacement
- Use 49452 for a gastrojejunostomy tube exchange. 49450 applies to gastrostomy or cecostomy tube replacement.
- 43762G-tube replacement
- 43762 is gastrostomy tube replacement without imaging or endoscopic guidance. 49450 includes fluoroscopic guidance and contrast assessment and also covers cecostomy tube replacement.
- 49465Tube examination
- 49465 is a fluoroscopic tube assessment without replacement. When the tube is replaced and the associated imaging is performed, report 49450 instead of separately reporting that same assessment.
49450 billing questions
How does this differ from 49451 or 49452?
49450 is for replacing a gastrostomy or cecostomy tube. Use 49451 for a duodenostomy or jejunostomy tube and 49452 for a gastrojejunostomy tube.
Can the fluoroscopic tube check be reported separately?
Fluoroscopic guidance, contrast assessment, and related image documentation for the replacement are included in 49450. Do not separately report a tube check for that same work.
When is 49450 preferable to 43762?
49450 describes replacement with fluoroscopic guidance. 43762 is for percutaneous gastrostomy tube replacement without imaging or endoscopic guidance.
Does 49450 have a global period?
It has a 0-day global period, so same-day preoperative and postoperative care is included.
Can modifier 50 be used for two tubes?
No. CMS identifies bilateral adjustment as inappropriate for this code. Report the service based on the documented procedure and applicable claim rules.
What documentation supports reporting 49450?
Document the existing gastrostomy or cecostomy tube, the replacement performed, and the imaging and contrast assessment supporting the exchange.
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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