CPT code 49491: Inguinal hernia repair, preterm infant, reducible2026 Medicare rate & RVUs

Medicare pays $763.88 for 49491 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 49491 covers

This code is for operative repair of an initial inguinal hernia in an infant born before 37 weeks’ gestation when the hernia is reducible. Pediatric surgeons and general surgeons commonly perform the repair in a hospital or other surgical setting. The operative report should establish that this is the initial repair, document the infant’s gestational age at birth, and describe the hernia as reducible. Record the side or sides treated and any other procedures performed during the session.

Choose this code for the preterm-infant category, not the neighboring category for a full-term infant. A 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral repair reported with modifier 50, payment is at 150%. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 49491 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

49491 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 49491 rate is calculated

Each of 49491’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 49491

49491 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

49491 compared with similar codes

How to choose

49492Inguinal hernia repairPreterm, incarcerated or strangulated

Both are initial repairs for preterm infants; 49491 is for a reducible hernia, while 49492 is for an incarcerated or strangulated hernia.

49495Hernia repairYounger than 6 months, reducible

This code is for a preterm infant. Use 49495 for an initial reducible repair in a full-term infant in the younger age category.

49496Inguinal hernia repairFull-term infant, incarcerated

49496 describes an incarcerated or strangulated hernia in a full-term infant in the younger age category; this code is for a preterm infant with a reducible hernia.

49500Inguinal hernia repairInitial, reducible, age 5 or younger

Both describe initial reducible inguinal hernia repair, but 49500 is for a different pediatric age category rather than a preterm infant.

Codes related to 49491

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates