$805.03
49465 evaluates an existing tube with fluoroscopic contrast. 49460 is for repositioning a gastrostomy or cecostomy tube.
On this page
CMS RVU26D · Effective 2026-10-01
49465 Tube examination Medicare reimbursement rates in Guam
Fluoroscopic contrast evaluation checks the position and function of an indwelling gastric, intestinal, or colostomy tube when a tube problem is suspected. Compare 49465 office and facility rates across CMS payment localities in Guam.
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 49465 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$143.87
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$25.38
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
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.
Diagnostic radiology
About 49465: Fluoroscopic feeding or ostomy tube examination
Fluoroscopic contrast evaluation checks the position and function of an indwelling gastric, intestinal, or colostomy tube when a tube problem is suspected.
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.
CMS billing rules for 49465
- 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 RVU0.60 · 15%
- Practice expense (office) RVU3.23 · 83%
- Malpractice RVU0.06 · 2%
10K
Medicare services in 2024 · #1466 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.
49465 compared with similar codes
Office rates for Guam, from the same CMS release.
$632.55
49465 is a diagnostic contrast examination; 49450 reports percutaneous replacement of a gastrostomy or cecostomy tube.
$808.78
Use 49465 for fluoroscopic examination of an existing gastrojejunostomy tube; use 49452 when that tube is replaced percutaneously.
Compare 49465 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.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
$143.87
Facility
$25.38
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 49465 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,820
- Code
- 49465
- Physician work
- 0.60
- Practice expense
- 3.23
- Malpractice
- 0.06
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.60 | × 1.000 | 0.6000 |
| Practice expense | 3.23 | × 1.137 | 3.6725 |
| Malpractice | 0.06 | × 0.579 | 0.0347 |
| Total RVUs | 4.3072 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$143.87
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.6 | 1 |
| Practice expense | 3.23 | 1.137 |
| Malpractice | 0.06 | 0.579 |
(0.6 × 1 + 3.23 × 1.137 + 0.06 × 0.579) × $33.4009 = $143.87
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.6 | 1 |
| Practice expense | 0.11 | 1.137 |
| Malpractice | 0.06 | 0.579 |
(0.6 × 1 + 0.11 × 1.137 + 0.06 × 0.579) × $33.4009 = $25.38
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 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.
5,81749451,,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
5,81949460,,Fix g/colon tube w/device,A,,0.94,20.31,,0.22,,0.12,21.37,1.28,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82049465,,Fluoro exam of g/colon tube,A,,0.60,3.23,,0.11,,0.06,3.89,0.77,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82149491,,Rpr hern preemie reduc,A,,12.22,7.39,NA,7.39,,3.26,22.87,22.87,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82249492,,Rpr ing hern premie blocked,A,,15.04,8.22,NA,8.22,,4.02,27.28,27.28,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82349495,,Rpr ing hernia baby reduc,A,,6.05,4.29,NA,4.29,,1.62,11.96,11.96,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014