$896.90
Choose 49441 for percutaneous placement of a duodenal or jejunal tube. Choose 49451 when replacing an existing tube through its established access tract.
On this page
CMS RVU26D · Effective 2026-10-01
49451 Feeding tube exchange Medicare reimbursement rates in Tennessee
Report this service when a clinician exchanges an existing percutaneous duodenal or jejunal feeding tube under fluoroscopic guidance and confirms its position. Compare 49451 office and facility rates across CMS payment localities in Tennessee.
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 49451 in Tennessee?
Tennessee 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
$549.94
1 of 1 localities have a supported rate.
Payment area: Tennessee
One mapped payment locality.
Facility setting
$72.06
1 of 1 localities have a supported rate.
Payment area: Tennessee
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.
Interventional radiology
About 49451: Percutaneous duodenal or jejunal tube replacement
Report this service when a clinician exchanges an existing percutaneous duodenal or jejunal feeding tube under fluoroscopic guidance and confirms its position.
Code 49451 describes exchanging a duodenostomy or jejunostomy tube through an established percutaneous tract. Fluoroscopy and contrast injections are used to guide the exchange and check tube position; radiological supervision and interpretation are part of the service. Interventional radiologists commonly perform the procedure in hospital or outpatient imaging settings when a tube is malfunctioning, displaced, or due for exchange. This is for an existing access tract, not creation of a new one.
Report the code when the documentation identifies the tube and tract exchanged and supports image-guided replacement. The fluoroscopy, contrast injections, and their interpretation are included in the code. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. If multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this tube exchange. An assistant is payable only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 49451
- 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 RVU1.79 · 10%
- Practice expense (office) RVU16.02 · 89%
- Malpractice RVU0.21 · 1%
4.6K
Medicare services in 2024 · #1927 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.
49451 compared with similar codes
Office rates for Tennessee, from the same CMS release.
$514.98
49450 covers percutaneous replacement of a gastrostomy or cecostomy tube; 49451 is for a duodenostomy or jejunostomy tube.
$666.02
49452 is for replacement of a gastrojejunal tube, which has gastric and jejunal portions. 49451 is for a duodenostomy or jejunostomy tube.
Compare 49451 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
Tennessee →
Office / nonfacility
$549.94
Facility
$72.06
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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 49451 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
5,817
- Code
- 49451
- Physician work
- 1.79
- Practice expense
- 16.02
- Malpractice
- 0.21
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.79 | × 1.000 | 1.7900 |
| Practice expense | 16.02 | × 0.909 | 14.5622 |
| Malpractice | 0.21 | × 0.537 | 0.1128 |
| Total RVUs | 16.4650 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Tennessee$549.94
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.79 | 1 |
| Practice expense | 16.02 | 0.909 |
| Malpractice | 0.21 | 0.537 |
(1.79 × 1 + 16.02 × 0.909 + 0.21 × 0.537) × $33.4009 = $549.94
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.79 | 1 |
| Practice expense | 0.28 | 0.909 |
| Malpractice | 0.21 | 0.537 |
(1.79 × 1 + 0.28 × 0.909 + 0.21 × 0.537) × $33.4009 = $72.06
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.
49451 billing questions
How is 49451 different from 49441?
49451 is for exchanging an existing duodenostomy or jejunostomy tube through its established tract. 49441 describes percutaneous placement of a duodenal or jejunal tube, rather than replacement.
Can fluoroscopy or contrast be billed separately?
No. Fluoroscopic guidance, contrast injections, and radiological supervision and interpretation are included in 49451 for the tube exchange.
When is modifier 50 appropriate?
Modifier 50 is inappropriate for 49451; the service concerns an individual tube and is not a bilateral procedure.
What documentation supports reporting 49451?
Document the existing duodenostomy or jejunostomy access, the exchange performed, and the image-guided confirmation of the replacement tube's position.
How does the multiple-procedure reduction affect this code?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
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.
5,81449442,,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
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
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780