CPT code 49496: Inguinal hernia repair, full-term infant, incarcerated2026 Medicare rate & RVUs in California

CMS doesn’t publish an office rate for 49496 in California.

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

What 49496 covers

This code represents operative repair of an initial inguinal hernia in a full-term infant younger than 6 months when the hernia is incarcerated or strangulated. A pediatric or general surgeon typically performs the repair in an operating room. The code includes the repair whether or not a hydrocele is treated during the same procedure. It is not the reducible-hernia code for this infant group, nor the code for a preterm infant or an older child.

The operative report should support the infant’s age and full-term status, that the hernia is initial, and the finding of incarceration or strangulation; document the side or sides repaired. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral repair with modifier 50 is paid at 150%. An assistant at surgery 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 49496 pays more and less in California

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

29 of 29 payment localities

How the 49496 rate is calculated

Each of 49496’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 49496

49496 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

49496 compared with similar codes

How to choose

49495Hernia repairYounger than 6 months, reducible

Both codes are for initial hernia repair in a full-term infant younger than 6 months. Choose 49496 for an incarcerated or strangulated hernia and 49495 for a reducible one.

49492Inguinal hernia repairPreterm, incarcerated or strangulated

This code is for a full-term infant younger than 6 months; 49492 is for a preterm infant with an incarcerated or strangulated hernia.

49501Inguinal hernia repairIncarcerated, age 6 months to under 5

Both address an incarcerated or strangulated initial hernia, but 49501 is for a child age 6 months to younger than 5 years.

Codes related to 49496

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