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    OpenPayerBilling CodesInitial Placement Procedures on the Abdomen, Peritoneum, and OmentumCPT cpt-49442-percutaneous-cecostomy-fluoroscopic-guidance
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    CPT 49442: Percutaneous Cecostomy or Colonic Tube Placement

    Medicare pays $773 on average nationally for this procedure.

    CPT code 49442 describes a percutaneous cecostomy or placement of a colonic tube performed through the skin under fluoroscopic guidance for management of fecal incontinence or severe constipation; service type: image-guided percutaneous colonic access procedure; typical site of service: outpatient interventional radiology suite or hospital-based radiology department where fluoroscopic guidance is available.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with refractory severe constipation or neurogenic fecal incontinence who has failed conservative therapy (bowel regimen, enemas, biofeedback) and is evaluated for a percutaneous cecostomy/colonic tube placement. The patient often presents from gastroenterology or colorectal clinic with chronic symptoms impacting quality of life, recurrent hospitalizations for impaction, or inability to manage stool. Pre-procedure workflow includes informed consent, review of prior imaging, coagulation assessment, and bowel preparation if indicated. The procedure is performed in an interventional radiology suite under fluoroscopic guidance with moderate sedation or monitored anesthesia care. A percutaneous access is obtained into the cecum or colon and a cecostomy or colonic tube is placed and secured for antegrade flushes or decompression. Post-procedure care includes tube management education, short observation for pain or bleeding, imaging if placement or complications are suspected, and outpatient follow-up with the referring specialist for tube exchanges and ongoing management.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49441Percutaneous cecostomy/colostomy, without image guidanceAlternative technique when imaging guidance is not used; often compared in coding to determine appropriate code selection.
    49443Revision or removal of percutaneous cecostomy/colonic tubeCommonly used for tube exchanges, revisions for malposition, or removal when tube is no longer needed.
    49444Endoscopic cecostomy placementAlternative approach when endoscopic access is used instead of percutaneous fluoroscopic technique.
    76937Ultrasound guidance for percutaneous proceduresMay be reported when real-time ultrasound guidance is used in addition to fluoroscopy for access.
    77002Fluoroscopic guidance for body proceduresReflects the imaging guidance component when fluoroscopy is used; used when technical imaging services are separately reportable.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    73Modifier 73 indicates a facility-level outpatient hospital or ASC procedure that was discontinued after the patient was prepared and taken to the procedure/operating room but before any anesthesia…- When to use: Apply CPT modifier 73 on the FACILITY (outpatient hospital or ASC) claim when the patient has been fully prepared and physically taken into the procedure/operating room but the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    207K00000X
    207L00000X
    208000000X
    363LA2200X
    213EG0000X
    207WX0009X
    133VN1501X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    E86.0Dehydration
    F98.4Stereotyped movement disorders
    F98.5Adult onset fluency disorder
    G91.9Hydrocephalus, unspecified
    G94Other disorders of brain in diseases classified elsewhere
    K56.7Ileus, unspecified
    K58.0Irritable bowel syndrome with diarrhea
    K58.9Irritable bowel syndrome, unspecified
    K59.00Constipation, unspecified
    K59.01Slow transit constipation

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

    CPT-49440-PERCUTANEOUS-FLUOROSCOPIC-GASTROSTOMY-TUBE-PLACEMENT

    CPT 49440: Percutaneous Fluoroscopic Gastrostomy Tube Placement

    CPT-49441-PERCUTANEOUS-FLUOROSCOPIC-JEJUNOSTOMY-DUODENOSTOMY-TUBE-PLACEMENT

    CPT 49441: Percutaneous Jejunostomy/Duodenostomy Tube Placement

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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