$784.34–$1,009.00
49446 converts an existing gastrostomy to G-J access. 49452 is for replacing an existing G-J tube.
On this page
CMS RVU26D · Effective 2026-10-01
49446 Tube conversion Medicare reimbursement rates in California
Reports fluoroscopic conversion of an established gastrostomy into gastrojejunal access when post-pyloric tube delivery is needed through the existing tract. Compare 49446 office and facility rates across CMS payment localities in California.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 49446 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
$822.44–$1057.39
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $234.95 per service.
Facility setting
$123.97–$138.42
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $14.45 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 49446 pays more and less in California
29 payment localities
$822.44 to $1057.39
Interventional radiology
About 49446: Percutaneous gastrostomy-to-gastrojejunostomy conversion
Reports fluoroscopic conversion of an established gastrostomy into gastrojejunal access when post-pyloric tube delivery is needed through the existing tract.
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.
CMS billing rules for 49446
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.98 · 13%
- Practice expense (office) RVU19.53 · 85%
- Malpractice RVU0.35 · 2%
3.1K
Medicare services in 2024 · #2155 by national volume
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.
49446 compared with similar codes
Office rates for California, from the same CMS release.
$611.98–$794.20
49450 replaces a gastrostomy tube while maintaining gastric access; 49446 changes the access to gastrojejunal delivery.
$845.79–$1,081.19
49440 places new percutaneous gastrostomy access. 49446 converts an established gastrostomy route to G-J access.
Compare 49446 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office $823.49 | Facility $125.02 |
| Chico | Office $822.44 | Facility $123.97 |
| El Centro | Office $822.49 | Facility $124.02 |
| Fresno | Office $822.44 | Facility $123.97 |
| Hanford-Corcoran | Office $822.44 | Facility $123.97 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $883.07 | Facility $129.16 |
| Madera | Office $822.44 | Facility $123.97 |
| Merced | Office $822.44 | Facility $123.97 |
| Modesto | Office $822.44 | Facility $123.97 |
| Napa | Office $971.50 | Facility $131.55 |
| Oxnard-Thousand Oaks-Ventura | Office $880.65 | Facility $127.37 |
| Redding | Office $822.44 | Facility $123.97 |
| Rest Of California | Office $822.44 | Facility $123.97 |
| Riverside-San Bernardino-Ontario | Office $826.24 | Facility $127.77 |
| Sacramento-Roseville-Folsom | Office $868.03 | Facility $126.86 |
| Salinas | Office $864.92 | Facility $126.31 |
| San Diego-Chula Vista-Carlsbad | Office $889.03 | Facility $126.83 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $1034.13 | Facility $135.55 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $1033.73 | Facility $135.15 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $1057.39 | Facility $138.42 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $1055.77 | Facility $136.80 |
| San Luis Obispo-Paso Robles | Office $850.48 | Facility $124.61 |
| Santa Cruz-Watsonville | Office $900.46 | Facility $126.15 |
| Santa Maria-Santa Barbara | Office $869.19 | Facility $126.11 |
| Santa Rosa-Petaluma | Office $909.84 | Facility $127.24 |
| Stockton | Office $822.44 | Facility $123.97 |
| Vallejo | Office $970.93 | Facility $130.98 |
| Visalia | Office $822.44 | Facility $123.97 |
| Yuba City | Office $822.44 | Facility $123.97 |
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,81249440,,Place gastrostomy tube perc,A,,3.83,19.34,,1.08,,0.43,23.60,5.34,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,81349441,,Place duod/jej tube perc,A,,4.41,24.27,,1.39,,0.71,29.39,6.51,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,81449442,,Place cecostomy tube perc,A,,3.66,18.18,,1.32,,0.36,22.20,5.34,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,81549446,,Change g-tube to g-j perc,A,,2.98,19.53,,0.45,,0.35,22.86,3.78,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,81649450,,Replace g/c tube perc,A,,1.33,15.41,,0.21,,0.15,16.89,1.69,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,81749451,,Replace duod/jej tube perc,A,,1.79,16.02,,0.28,,0.21,18.02,2.28,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,81849452,,Replace g-j tube perc,A,,2.79,18.69,,0.41,,0.30,21.78,3.50,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00