$870.71
Choose 49442 for a tube entering the cecum; choose 49440 when the percutaneous tube enters the stomach.
On this page
CMS RVU26D · Effective 2026-10-01
49442 Cecostomy tube Medicare reimbursement rates in Hawaii
Report percutaneous cecostomy tube placement when a clinician establishes image-guided access to the cecum, often for antegrade bowel irrigation. Compare 49442 office and facility rates across CMS payment localities in Hawaii.
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 49442 in Hawaii?
Hawaii 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
$819.63
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$179.34
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.
Gastrointestinal procedure
About 49442: Percutaneous cecostomy tube placement
Report percutaneous cecostomy tube placement when a clinician establishes image-guided access to the cecum, often for antegrade bowel irrigation.
A clinician advances a tube through the abdominal wall into the cecum using percutaneous, fluoroscopic guidance. Interventional radiologists commonly perform this procedure in a facility setting. A cecostomy can provide access for antegrade colonic irrigation in patients with severe refractory constipation or neurogenic bowel. The service is distinct from access to the stomach, duodenum, or jejunum.
Report this code for placement of a new cecostomy tube, not routine exchange of an existing tube. Document the cecal target, percutaneous approach, tube placement, and imaging guidance. Related postoperative visits during the 10-day global period are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures receive the standard multiple-procedure reduction. Report one unit for the cecal access; modifier 50 is inappropriate. An assistant is paid only when medical necessity is documented; co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 49442
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are 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 RVU3.66 · 16%
- Practice expense (office) RVU18.18 · 82%
- Malpractice RVU0.36 · 2%
31
Medicare services in 2024 · #5649 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.
49442 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$1,082.73
Choose 49442 for cecal access. Code 49441 identifies percutaneous placement targeting the duodenum or jejunum.
$632.55
Use 49442 for new percutaneous cecostomy tube placement; use 49450 when replacing an existing gastrostomy or cecostomy tube.
Compare 49442 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
$819.63
Facility
$179.34
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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 49442 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,814
- Code
- 49442
- Physician work
- 3.66
- Practice expense
- 18.18
- Malpractice
- 0.36
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.66 | × 1.000 | 3.6600 |
| Practice expense | 18.18 | × 1.137 | 20.6707 |
| Malpractice | 0.36 | × 0.579 | 0.2084 |
| Total RVUs | 24.5391 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$819.63
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.66 | 1 |
| Practice expense | 18.18 | 1.137 |
| Malpractice | 0.36 | 0.579 |
(3.66 × 1 + 18.18 × 1.137 + 0.36 × 0.579) × $33.4009 = $819.63
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.66 | 1 |
| Practice expense | 1.32 | 1.137 |
| Malpractice | 0.36 | 0.579 |
(3.66 × 1 + 1.32 × 1.137 + 0.36 × 0.579) × $33.4009 = $179.34
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.
49442 billing questions
How is this different from percutaneous gastrostomy placement?
This code is for a tube placed into the cecum. Use the gastrostomy code when the tube enters the stomach.
How is this different from duodenal or jejunal tube placement?
The target anatomy controls code selection: this service accesses the cecum, while the related code for duodenal or jejunal placement targets the small bowel.
Can this code be used for replacement of an existing cecostomy tube?
No. This code describes placement of a new tube; code 49450 describes percutaneous replacement of a gastrostomy or cecostomy tube.
Should modifier 50 be reported?
No. A single cecal access is reported once, and modifier 50 is inappropriate for this procedure.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure payment.
When is an assistant payable?
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.
5,81149436,,Embedded ip cath exit-site,A,,2.65,13.51,,1.99,,0.68,16.84,5.32,0,010,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
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