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CPT 49450: Fluoroscopic Replacement of Gastrostomy/Cecostomy Tube

CPT code 49450 covers fluoroscopically guided percutaneous replacement of existing gastrostomy, cecostomy, or other colon tubes. This procedure addresses dislodged or malfunctioning enteric tubes and is a common interventional radiology service that supports ongoing enteral access for nutrition, decompression, or medication delivery. Nationally, 49450 is relevant for hospitals, outpatient departments, and radiology practices because timely tube exchange reduces clinical complications and the need for emergent care.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview of the service, expected sites of care, common modifiers and procedural context, and where to look for payer-specific coverage patterns. The publication summarizes typical clinical indications, workflow implications for interventional radiology and gastroenterology teams, and billing considerations that affect claims submission and reimbursement. Data not available in the input will be noted where applicable.

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Billing Code Overview

CPT code 49450 describes the fluoroscopically guided replacement of an existing gastrostomy tube, cecostomy tube, or other colon tube through the skin. The procedure is performed when the existing tube has become dislodged or no longer functions properly and requires exchange under imaging guidance.

Service type: Percutaneous tube replacement under fluoroscopic guidance
Typical site of service: Interventional radiology suite, hospital outpatient department, or other facility equipped for fluoroscopic procedures

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CPT 49450: Fluoroscopic Replacement of Gastrostomy/Cecostomy Tube

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Get alerted when payer policies referencing 49450 are released or updated.

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Billing Code Overview

Service type: Percutaneous tube replacement under fluoroscopic guidance
Typical site of service: Interventional radiology suite, hospital outpatient department, or other facility equipped for fluoroscopic procedures

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or pediatric patient with an existing percutaneous gastrostomy or cecostomy tube who presents with tube dislodgement, malfunction, blockage, breakage, or deterioration of the internal retention device. Common presenting features include inability to administer enteral nutrition or medications, leakage around the stoma, external tube fracture, or inadvertent removal. The patient is evaluated by interventional radiology or a gastroenterology team; imaging review confirms tube position is absent or nonfunctional. Under conscious sedation or local anesthesia in an outpatient fluoroscopy suite, the provider uses fluoroscopic guidance to remove the nonfunctional tube and replace it with an appropriate-sized gastrostomy or cecostomy tube through the mature stoma tract or via image-guided exchange technique. Post-replacement, contrast is instilled under fluoroscopy to confirm intragastric or intracolonic placement and to evaluate for leak. The patient is observed for immediate complications (bleeding, peritonitis, aspiration) and discharged with instructions for tube care and enteral access use.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced Services	When the exchange procedure is partially reduced or not completed as originally intended (e.g., limited due to anatomy or patient instability).
`53`	Discontinued Procedure	When the procedure is started but then stopped before completion for patient safety reasons.
`59`	Distinct Procedural Service	When another distinct procedural service is performed the same day and the exchange is unrelated (use only when documentation supports distinctness).
`76`	Repeat Procedure by Same Physician	When the same provider repeats the tube exchange procedure later the same day.
`77`	Repeat Procedure by Another Physician	When a second provider repeats the exchange procedure later the same day.
`78`	Return to OR for Related Procedure During Postop Period	When a return to the operating/procedure room is required for a related complication (e.g., revision for leak) during the global period.
`79`	Unrelated Procedure or Service by Same Physician During Postop Period	When an unrelated procedure is performed during the global period.
`26`	Professional Component	When reporting only the physician professional component separate from technical component billing.
`TC`	Technical Component	When reporting only the technical component (facility, equipment, radiology technologist) separate from physician services.
`52`	Reduced Services	When a limited exchange is performed due to patient condition or tract issues (note: `52` listed once clinically relevant).
`QX`	Modifier X: CRNA Service with Medical Direction by a Physician	When a CRNA provides anesthesia services under medical direction and the payer requires this modifier.
`QY`	Medical Direction of One CRNA by a Physician	When the physician provides medical direction for CRNA services.
`59`	Distinct Procedural Service	For separate, distinct services during same encounter (avoid overuse; use only with clear documentation).

Taxonomy Code	Specialty	Notes
`207K00000X`	Interventional Radiology	Primary specialty performing fluoroscopically guided tube exchanges in many centers.
`2073P0001X`	Diagnostic Radiology	Radiologists often perform image-guided enteral tube exchanges.
`208000000X`	Gastroenterology	Gastroenterologists may perform tube exchanges in endoscopy or with fluoroscopic assistance.
`363L00000X`	General Surgery	Surgeons with percutaneous access expertise perform exchanges when operative management is required.
`374U00000X`	Pediatric Surgery	Pediatric surgeons manage tube exchanges in infants and children when pediatric expertise is needed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T85.698A`	Other mechanical complication of other specified internal prosthetic devices, implants and grafts, initial encounter	Represents mechanical failure or malfunction of an enteral tube requiring replacement.
`T18.1XXA`	Foreign body in esophagus, initial encounter	Reflects inadvertent migration or malposition concern prompting imaging and exchange when relevant to upper enteral access (used cautiously).
`K63.4`	Fistula of intestine	Enterocutaneous fistula can complicate gastrostomy/cecostomy function and necessitate revision or exchange.
`K91.2`	Complications of gastrostomy, enterostomy and other intestinal stomas	Directly related to complications prompting tube replacement such as leakage, infection, or obstruction.
`R63.5`	Abnormal weight gain	Contextual diagnosis when enteral access is required for nutritional therapy and tube function is critical.
`Z98.890`	Other specified postprocedural states	Used for history of prior gastrostomy/cecostomy when documenting ongoing enteral access needs.
`Z43.1`	Encounter for attention to gastrostomy	Used for encounters specific to care and maintenance of gastrostomy, including tube exchange.
`Z46.1`	Encounter for fitting and adjustment of gastrostomy	Used for procedures related to enteral access device management, including replacement.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49440`	Percutaneous placement of gastrostomy tube	Often performed initially when creating the gastrostomy; `49450` is used for subsequent exchanges.
`43246`	Endoscopic placement of percutaneous gastrostomy tube, without laparoscopic assistance	Alternate method for initial placement; may precede later fluoroscopic exchanges.
`49083`	Replacement of gastrostomy tube, delayed or complicated (example code for device replacement)	Related to tube replacement scenarios; used when replacement is performed in a different clinical context or technique (verify payer rules).
`77002`	Fluoroscopic guidance for central venous access (example fluoroscopy guidance code)	Fluoroscopic guidance codes are related for documentation of imaging guidance during procedures; facility billing often captures imaging resources.
`99213`	Office or other outpatient visit for evaluation and management	Pre-procedure or post-procedure outpatient evaluation related to the exchange may be billed separately if medically appropriate and documented.

CPT 49451: Fluoroscopic Duodenostomy/Jejunostomy Tube Replacement

CPT-49452-PERCUTANEOUS-GASTROJEJUNOSTOMY-TUBE-REPLACEMENT-FLUOROSCOPIC

CPT 49452: Fluoroscopic Replacement of Gastrojejunostomy Tube

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced Services	When the exchange procedure is partially reduced or not completed as originally intended (e.g., limited due to anatomy or patient instability).
`53`	Discontinued Procedure	When the procedure is started but then stopped before completion for patient safety reasons.
`59`	Distinct Procedural Service	When another distinct procedural service is performed the same day and the exchange is unrelated (use only when documentation supports distinctness).
`76`	Repeat Procedure by Same Physician	When the same provider repeats the tube exchange procedure later the same day.
`77`	Repeat Procedure by Another Physician	When a second provider repeats the exchange procedure later the same day.
`78`	Return to OR for Related Procedure During Postop Period	When a return to the operating/procedure room is required for a related complication (e.g., revision for leak) during the global period.
`79`	Unrelated Procedure or Service by Same Physician During Postop Period	When an unrelated procedure is performed during the global period.
`26`	Professional Component	When reporting only the physician professional component separate from technical component billing.
`TC`	Technical Component	When reporting only the technical component (facility, equipment, radiology technologist) separate from physician services.
`52`	Reduced Services	When a limited exchange is performed due to patient condition or tract issues (note: `52` listed once clinically relevant).
`QX`	Modifier X: CRNA Service with Medical Direction by a Physician	When a CRNA provides anesthesia services under medical direction and the payer requires this modifier.
`QY`	Medical Direction of One CRNA by a Physician	When the physician provides medical direction for CRNA services.
`59`	Distinct Procedural Service	For separate, distinct services during same encounter (avoid overuse; use only with clear documentation).

Taxonomy Code	Specialty	Notes
`207K00000X`	Interventional Radiology	Primary specialty performing fluoroscopically guided tube exchanges in many centers.
`2073P0001X`	Diagnostic Radiology	Radiologists often perform image-guided enteral tube exchanges.
`208000000X`	Gastroenterology	Gastroenterologists may perform tube exchanges in endoscopy or with fluoroscopic assistance.
`363L00000X`	General Surgery	Surgeons with percutaneous access expertise perform exchanges when operative management is required.
`374U00000X`	Pediatric Surgery	Pediatric surgeons manage tube exchanges in infants and children when pediatric expertise is needed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T85.698A`	Other mechanical complication of other specified internal prosthetic devices, implants and grafts, initial encounter	Represents mechanical failure or malfunction of an enteral tube requiring replacement.
`T18.1XXA`	Foreign body in esophagus, initial encounter	Reflects inadvertent migration or malposition concern prompting imaging and exchange when relevant to upper enteral access (used cautiously).
`K63.4`	Fistula of intestine	Enterocutaneous fistula can complicate gastrostomy/cecostomy function and necessitate revision or exchange.
`K91.2`	Complications of gastrostomy, enterostomy and other intestinal stomas	Directly related to complications prompting tube replacement such as leakage, infection, or obstruction.
`R63.5`	Abnormal weight gain	Contextual diagnosis when enteral access is required for nutritional therapy and tube function is critical.
`Z98.890`	Other specified postprocedural states	Used for history of prior gastrostomy/cecostomy when documenting ongoing enteral access needs.
`Z43.1`	Encounter for attention to gastrostomy	Used for encounters specific to care and maintenance of gastrostomy, including tube exchange.
`Z46.1`	Encounter for fitting and adjustment of gastrostomy	Used for procedures related to enteral access device management, including replacement.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49440`	Percutaneous placement of gastrostomy tube	Often performed initially when creating the gastrostomy; `49450` is used for subsequent exchanges.
`43246`	Endoscopic placement of percutaneous gastrostomy tube, without laparoscopic assistance	Alternate method for initial placement; may precede later fluoroscopic exchanges.
`49083`	Replacement of gastrostomy tube, delayed or complicated (example code for device replacement)	Related to tube replacement scenarios; used when replacement is performed in a different clinical context or technique (verify payer rules).
`77002`	Fluoroscopic guidance for central venous access (example fluoroscopy guidance code)	Fluoroscopic guidance codes are related for documentation of imaging guidance during procedures; facility billing often captures imaging resources.
`99213`	Office or other outpatient visit for evaluation and management	Pre-procedure or post-procedure outpatient evaluation related to the exchange may be billed separately if medically appropriate and documented.

CPT 49451: Fluoroscopic Duodenostomy/Jejunostomy Tube Replacement

CPT-49452-PERCUTANEOUS-GASTROJEJUNOSTOMY-TUBE-REPLACEMENT-FLUOROSCOPIC

CPT 49452: Fluoroscopic Replacement of Gastrojejunostomy Tube

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 49450: Fluoroscopic Replacement of Gastrostomy/Cecostomy Tube

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Billing Code Overview

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OpenPayer

CPT 49450: Fluoroscopic Replacement of Gastrostomy/Cecostomy Tube

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 49450: Fluoroscopic Replacement of Gastrostomy/Cecostomy Tube

Sign up for cpt 49450 policy alerts

Billing Code Overview

CPT 49450: Fluoroscopic Replacement of Gastrostomy/Cecostomy Tube

Sign up for cpt 49450 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical scenario and site of service does CPT 49450 cover?

Which modifiers are commonly used with CPT 49450 and when are they applied?

What are common related CPT codes to consider when billing for a tube replacement under fluoroscopy?

Which ICD-10 diagnosis codes are relevant when submitting a claim for CPT 49450?

Which payers are mentioned for coverage of CPT 49450 and does the page provide reimbursement rates?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical scenario and site of service does CPT 49450 cover?

Which modifiers are commonly used with CPT 49450 and when are they applied?

What are common related CPT codes to consider when billing for a tube replacement under fluoroscopy?

Which ICD-10 diagnosis codes are relevant when submitting a claim for CPT 49450?

Which payers are mentioned for coverage of CPT 49450 and does the page provide reimbursement rates?

References