2025 CPT code 49440
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Percutaneous insertion of a gastrostomy tube under fluoroscopic guidance, including contrast injections, image documentation, and report.
Modifiers may be applicable depending on the circumstances of the procedure (e.g., 59 for distinct procedural service, 22 for increased procedural service). Consult current CPT guidelines and payer-specific policies.
Medical necessity is established when a patient is unable to receive adequate nutrition or hydration via the oral route due to conditions such as esophageal obstruction, severe neurological impairment, or other conditions affecting swallowing.Documentation of the underlying condition is crucial for justifying the procedure.
The physician is responsible for patient preparation, anesthesia (if needed), tube placement, fluoroscopic guidance, contrast injection, securing the tube, and post-procedure care.The physician must document the procedure comprehensively with images and a detailed report.
In simple words: A feeding tube (gastrostomy tube) is placed through the skin and into the stomach using X-ray guidance.A small needle is inserted, then a guidewire, and finally a larger tube.A special dye is used to check the tube's position and make sure it's working correctly.
This procedure involves the percutaneous placement of a gastrostomy tube using fluoroscopic guidance.The physician inserts an orogastric or nasogastric tube, confirms its position via imaging, and insufflates the stomach with air. Under fluoroscopic guidance, the abdominal wall is punctured with a needle, a guidewire is inserted, and the needle is removed.A dilator is used for serial dilatation, and a loop catheter is advanced into the stomach with contrast injections at each step to ensure proper placement and patency. The tube is secured, instruments are removed, and sterile dressings are applied.The procedure is documented with images and a report.
Example 1: A patient with esophageal cancer is unable to swallow and requires nutritional support.A percutaneous gastrostomy tube is placed using 49440., A patient with severe neurological impairment has difficulty swallowing.A gastrostomy tube is placed via 49440 to facilitate nutrition., A patient has undergone significant weight loss due to dysphagia (difficulty swallowing), requiring a gastrostomy tube.49440 is used to document the percutaneous placement under fluoroscopy.
* Pre-procedure assessment including patient history and physical exam.* Informed consent.* Fluoroscopic images of the procedure.* Documentation of contrast injection(s).* Details of tube placement and confirmation of patency.* Post-procedure assessment and instructions.* Operative report with images.
** The use of fluoroscopy is integral to this procedure and must be clearly documented.Accurate imaging and documentation are critical for proper reimbursement.
- Revenue Code: P6D (MINOR PROCEDURES - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: Information not available in provided text.Refer to current Medicare Physician Fee Schedule for RVU values.
- Global Days: Information not provided.Refer to CPT guidelines and payer-specific policies for global period information.
- Payment Status: Active
- Modifier TC rule: Not applicable.49440 encompasses the entire procedure.
- Fee Schedule: Information not available in provided text.Refer to historical Medicare Physician Fee Schedules.
- Specialties:Gastroenterology, Surgery, Interventional Radiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center