$521.66–$587.01
Choose 49450 for percutaneous replacement of a gastrostomy or cecostomy tube. Choose 49452 when the existing tube is a gastrojejunostomy tube.
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CMS RVU26D · Effective 2026-10-01
49452 G-J tube replacement Medicare reimbursement rates in Pennsylvania
Percutaneous replacement of an existing gastrojejunostomy tube restores enteral access when the tube is displaced, obstructed, damaged, or otherwise needs exchange. Compare 49452 office and facility rates across CMS payment localities in Pennsylvania.
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 49452 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$675.73–$756.68
2 of 2 localities have a supported rate.
Facility setting
$115.23–$121.08
2 of 2 localities have a supported rate.
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.
Interventional radiology
About 49452: Percutaneous gastrojejunostomy tube replacement
Percutaneous replacement of an existing gastrojejunostomy tube restores enteral access when the tube is displaced, obstructed, damaged, or otherwise needs exchange.
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.
CMS billing rules for 49452
- 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 RVU2.79 · 13%
- Practice expense (office) RVU18.69 · 86%
- Malpractice RVU0.30 · 1%
10.7K
Medicare services in 2024 · #1441 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.
49452 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$557.62–$626.25
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.
$709.41–$794.34
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.
Compare 49452 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$756.68
Facility
$121.08
Rest Of Pennsylvania →
Office / nonfacility
$675.73
Facility
$115.23
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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 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.
5,81549446,,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
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