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    OpenPayerBilling CodesReplacement Procedures on the Abdomen, Peritoneum, and OmentumCPT cpt-49451-duodenostomy-jejunoostomy-tube-exchange-fluoroscopic
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    CPT 49451: Percutaneous Replacement of Duodenostomy/Jejunostomy Tube

    Medicare pays $629 on average nationally for this procedure.

    CPT code 49451 describes percutaneous replacement of an existing duodenostomy or jejunostomy tube under fluoroscopic guidance; this is a tube exchange procedure performed when a feeding tube is dislodged or malfunctions. Service type: image-guided percutaneous tube replacement; typical site of service: interventional radiology suite or hospital outpatient department. Data not available in the input.

    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 68-year-old male with a history of head and neck cancer treated with surgery and radiation presents to the interventional radiology suite after his long-standing radiologically-placed jejunostomy tube becomes dislodged and no longer drains enteral formula. The patient has persistent malnutrition and requires continued enteral access for nutrition and medication administration. After review of recent abdominal radiographs to confirm tube position and assess for retained fragments, the interventional radiologist performs an exchange of the existing jejunostomy tube under fluoroscopic guidance using the existing cutaneous tract. Local anesthesia and conscious sedation are administered by the procedural team. The procedure includes removal of the nonfunctional tube, tract cannulation, contrast injection under fluoroscopy to confirm jejunal location, and placement of a replacement jejunostomy tube with internal retention mechanism. Post-procedure images confirm appropriate intraluminal placement and no immediate complications. The patient is observed in the recovery area, provided tube care and use instructions, and discharged home in stable condition with follow-up arranged.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43246Endoscopic placement of percutaneous gastrostomy tube, percutaneous endoscopic gastrostomy (PEG)Alternative method for enteral access placement; may precede or follow radiologic exchange if endoscopic approach chosen.
    49440Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidanceRelated percutaneous fluoroscopic placement procedure for primary gastrostomy tubes; same imaging modality and setting.
    43280Endoscopic retrograde cholangiopancreatography (ERCP) with stent placementNot routine with jejunostomy exchange but may be performed in patients with complex anatomy or concurrent biliary issues.
    76140Radiologic supervision and interpretation, injection procedure for evaluation of enteric tube placement (fluoroscopy)Imaging supervision and interpretation codes commonly reported with fluoroscopically guided enteric tube procedures.
    49452Creation of tunnel for jejunostomy tube or replacement with radiologic guidance (if applicable)Related procedural code for more complex exchanges requiring tract dilation or replacement techniques.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    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…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    208800000X
    163W00000X
    208000000X
    163WX0601X
    207SG0205X
    2278H0200X
    332800000X

    Related ICD-10-CM Codes

    22 rows

    ICD-10-CM CodeDescription
    B37.7Candidal sepsis
    E86.0Dehydration
    E86.1Hypovolemia
    K29.70Gastritis, unspecified, without bleeding
    K31.1Adult hypertrophic pyloric stenosis
    K31.89Other diseases of stomach and duodenum
    K56.2Volvulus
    K57.20Diverticulitis of large intestine with perforation and abscess without bleeding
    K57.30Diverticulosis of large intestine without perforation or abscess without bleeding
    K91.83Postprocedural hepatorenal syndrome

    Showing 1–10 of 22

    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-49450-GASTROSTOMY-CECOSTOMY-TUBE-REPLACEMENT-FLUOROSCOPY

    CPT 49450: Gastrostomy/Cecostomy Tube Replacement under Fluoroscopy

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

    CPT 49452: Replacement of Gastrojejunostomy Tube, Fluoroscopic Guidance

    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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