CPT code 49496: Inguinal hernia repair, full-term infant, incarcerated2026 Medicare rate & RVUs in Massachusetts
Repair of an initial incarcerated or strangulated inguinal hernia in a full-term infant younger than 6 months, with or without hydrocele treatment.
CMS doesn’t publish an office rate for 49496 in Massachusetts.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | $639.98 |
| Rest of Massachusetts | Unavailable | $595.43 |
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.
How the rate is built · 49496
RVUs × geographic indexes × conversion factor
Work9.18
9.18 RVUs× 1.000 GPCI
Practice expense6.21
6.21 RVUs× 1.000 GPCI
Malpractice2.46
2.46 RVUs× 1.000 GPCI
Adjusted RVUs
17.8500
Conversion factor
$33.4009
Medicare rate
$596.21
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49496
49496 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49496
Inguinal hernia repair, full-term infant, incarcerated
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49496
Inguinal hernia repair, full-term infant, incarcerated
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
49496 without 50 · national facility
$596.21
Inguinal hernia repair, full-term infant, incarcerated
49496-50 · Bilateral: 150%
$894.32
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
49496 compared with similar codes
Compare codes · National
4 codes, side by side
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.
49496 billing questions
How do I distinguish this code from 49495?
Use 49496 when the initial hernia is incarcerated or strangulated. Code 49495 is for a reducible hernia in the same full-term infant age group.
Does the code include hydrocele treatment performed with the repair?
Yes. This repair code covers the service whether or not a hydrocele is treated during the same operation.
What documentation supports reporting 49496?
Document the infant’s age and full-term status, that this is an initial hernia, the operative finding of incarceration or strangulation, and the side repaired.
How is a bilateral repair reported?
When both sides are repaired, report modifier 50; CMS pays the bilateral procedure at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care.
Can an assistant or co-surgeon be paid?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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
Show the CMS file lines behind this rate
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