Billing code 49452: G-J tube replacementMedicare rate & RVUs in Oregon
Percutaneous replacement of an existing gastrojejunostomy tube restores enteral access when the tube is displaced, obstructed, damaged, or otherwise needs exchange.
Medicare pays $722.00–$795.69 for 49452 in the office in Oregon, from Rest Of Oregon to Portland. Which amount applies depends on the service address.
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 9 sections
What 49452 covers
An interventional radiologist or other physician with image-guided access expertise replaces an existing gastrojejunostomy tube through its established percutaneous tract. The service is used when the tube is displaced, obstructed, damaged, or requires exchange while maintaining gastric access and jejunal feeding access. Fluoroscopy may guide the exchange and verify tube position; it is included when performed. This is a replacement service, not initial creation of a gastrostomy or jejunostomy tract.
Report 49452 for percutaneous exchange of a G-J tube, rather than a G-tube or a duodenal or jejunal tube alone. The record should identify the existing tube, reason for replacement, access used, device placed, and any imaging confirmation. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate; assistant-at-surgery payment requires medical-necessity documentation, and co-surgeon and team-surgery reporting 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 49452 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $795.69 | $117.35 |
| Rest Of Oregon | $722.00 | $113.87 |
How the 49452 rate is calculated
Each of 49452’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 · 49452
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.79Practice expense 18.69Malpractice 0.30
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49452
The CMS indicators that decide how 49452 is paid alongside other services.
CMS payment indicators · 49452
G-J 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
49452 without 51 · national office
$727.47
G-J tube replacement
49452-51 · Second procedure: 50%
$363.74
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%).
49452 compared with similar codes
Compare codes
49452 vs 49450 vs 49451 vs 49446: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49450Feeding tube replacement
- Choose 49450 for percutaneous replacement of a gastrostomy or cecostomy tube. Choose 49452 when the existing tube is a gastrojejunostomy tube.
- 49451Feeding tube exchange
- Choose 49451 for replacement of a duodenostomy or jejunostomy tube. Code 49452 is for replacement of a tube that provides both gastric and jejunal access.
- 49446Tube conversion
- Code 49446 describes changing an existing gastrostomy tube to a G-J tube. Code 49452 replaces a G-J tube that is already in place.
49452 billing questions
How is 49452 different from replacing a G-tube or a jejunal tube?
Use 49452 when the existing tube is a gastrojejunostomy tube. Code 49450 addresses a gastrostomy or cecostomy tube, while 49451 addresses a duodenostomy or jejunostomy tube.
Can fluoroscopy be reported separately with 49452?
Fluoroscopy used to guide or verify the replacement is included when performed. Do not separately report it as a distinct imaging service for that same exchange.
What documentation supports reporting 49452?
Document the existing G-J tube, why it needed replacement, the percutaneous access used, the tube placed, and imaging or position confirmation when performed.
Does modifier 50 apply, and when can an assistant be paid?
Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeon and team-surgery reporting are not permitted.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure. If other procedures are performed in the same session, CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full and others at 50%.
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
Fee sheets
Put 49452 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →