Billing code 49460: Tube fixationMedicare rate & RVUs
Percutaneous fixation secures an existing gastrostomy or cecostomy tube with a device when the tube needs stabilization rather than replacement.
Medicare pays $713.78 for 49460 nationally in the office and $42.75 in a hospital or facility. Local office rates run $616.18–$1,015.21.
Medicare rate · 49460
Tube fixation
Swap in your local Medicare rate.
- Work RVUs
- 0.94
- Total RVUs
- 21.37
- Global days
- 000
National rate · 2026
$713.78
Office setting, before claim adjustments.
See every locality for 49460 → · 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 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.
Where 49460 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
$616.18 to $1015.21
109 of 109 payment localities
49460 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.
$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
Swap in your local Medicare rate.
Work 0.94Practice expense 20.31Malpractice 0.12
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49460
The CMS indicators that decide how 49460 is paid alongside other services.
CMS payment indicators · 49460
Tube fixation
| 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
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%).
49460 compared with similar codes
Compare codes
49460 vs 49450 vs 49465 vs 49440 vs 49442: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49450Feeding tube replacement
- 49460 secures an existing gastrostomy or cecostomy tube with a fixation device; 49450 is for replacing the tube.
- 49465Tube examination
- 49465 is a radiologic evaluation of an existing gastrostomy, duodenostomy, jejunostomy, or cecostomy tube. It evaluates the tube rather than fixing it.
- 49440Gastrostomy placement
- 49440 covers percutaneous placement of a gastrostomy tube. Choose 49460 when the service fixes an existing gastrostomy tube instead of placing a new one.
- 49442Cecostomy tube
- 49442 covers percutaneous placement of a cecostomy tube. Choose 49460 for fixation of an existing cecostomy tube.
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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