Summary & Overview
CPT 49446: Fluoroscopic Conversion of Gastrostomy to Gastrojejunostomy Tube
CPT code 49446 denotes a fluoroscopically guided, percutaneous conversion of an existing gastrostomy tube to a gastrojejunostomy tube. This interventional procedure is used when patients with established gastrostomy access cannot tolerate gastric feeding and require post-pyloric enteral delivery into the jejunum. Nationally, the code captures a specific image-guided enteral access conversion that spans inpatient and outpatient interventional settings and has implications for clinical pathways, utilization oversight, and payer coverage policies.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for tube conversion, typical sites of service, and common billing considerations. The publication summarizes benchmark utilization patterns, relevant policy and coverage trends affecting reimbursement and prior authorization, and the clinical scenarios that commonly lead to use of this code. Where input data is missing, the publication notes those gaps explicitly. This resource is intended for revenue cycle leaders, interventionalists, and policy analysts seeking a national-level briefing on coding, clinical context, and payer considerations for CPT code 49446.
Billing Code Overview
CPT code 49446 describes the fluoroscopic, percutaneous conversion of an existing gastrostomy tube to a gastrojejunostomy tube. The procedure is performed using a minimally invasive, image-guided approach through the skin to extend enteral access into the jejunum for patients who cannot tolerate gastric feeding via an existing gastrostomy tube.
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Service type: Image-guided percutaneous gastrojejunostomy tube conversion (procedural, interventional)
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Typical site of service: Hospital outpatient department or ambulatory surgical center (fluoroscopy-equipped interventional suite)
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with an existing percutaneous gastrostomy tube who develops intolerance to gastric feeds because of severe gastroparesis, recurrent aspiration, or persistent gastroesophageal reflux despite medical management. The patient often presents from a long-term care facility or hospital with ongoing tube feed needs, poor gastric emptying, or aspiration events. The interventional radiology team performs 49446 under fluoroscopic guidance in an outpatient interventional radiology suite or inpatient fluoroscopy-capable procedure room. The workflow includes review of recent imaging and labs, informed consent, sedation or monitored anesthesia care as indicated, sterile preparation of the gastrostomy site, removal or conversion of the existing gastrostomy tube, advancement of the jejunal extension through the gastrostomy tract into the jejunum under fluoroscopic visualization, confirmation of tip position with contrast, securing the gastrojejunostomy tube, and post-procedure monitoring for feed tolerance and complications such as malposition, leakage, or infection. Documentation includes indication, informed consent, anesthesia type, fluoroscopic guidance, tube type and size, contrast used, final tip location, and post-procedure feeding instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician's professional interpretation if technical component billed separately. |