CPT code 49500: Inguinal hernia repair, initial, reducible, age 5 or younger2026 Medicare rate & RVUs in Illinois
Reports open repair of an initial, reducible inguinal hernia in a child age 5 years or younger, rather than an incarcerated or recurrent hernia.
CMS doesn’t publish an office rate for 49500 in Illinois.
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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On this page 9 sections
What 49500 covers
A surgeon repairs a first-time inguinal hernia in a child age 5 years or younger when the hernia is reducible. The operation typically involves exposing the inguinal canal, returning the hernia contents to the abdomen, and repairing the defect and hernia sac. Pediatric and general surgeons commonly perform the repair in an operating room, including for infants and young children with a groin bulge that can be reduced.
Choose this code when the record supports an initial inguinal hernia, reducibility, and the patient’s age; document the operative findings and repair performed. An incarcerated or strangulated hernia belongs to a different code, as does a repair of a recurrent hernia. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral repair with modifier 50, CMS pays at 150%. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Assistant-at-surgery payment may be available; 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 49500 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | $480.01 |
| East St. Louis, IL | Unavailable | $449.88 |
| Rest of Illinois | Unavailable | $425.93 |
| Suburban Chicago, IL | Unavailable | $457.41 |
How the 49500 rate is calculated
Each of 49500’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 · 49500
RVUs × geographic indexes × conversion factor
Work5.69
5.69 RVUs× 1.000 GPCI
Practice expense5.15
5.15 RVUs× 1.000 GPCI
Malpractice1.51
1.51 RVUs× 1.000 GPCI
Adjusted RVUs
12.3500
Conversion factor
$33.4009
Medicare rate
$412.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49500
49500 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49500
Inguinal hernia repair, initial, reducible, age 5 or younger
| 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 · 49500
Inguinal hernia repair, initial, reducible, age 5 or younger
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
49500 without 50 · national facility
$412.50
Inguinal hernia repair, initial, reducible, age 5 or younger
49500-50 · Bilateral: 150%
$618.75
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).
49500 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49501Inguinal hernia repairIncarcerated, age 6 months to under 5
- Both are initial repairs for young children. Choose 49500 when the hernia is reducible; 49501 describes an incarcerated or strangulated hernia.
- 49505Inguinal hernia repairInitial, reducible, age 5+
- Both are for initial, reducible inguinal hernias; the age group distinguishes them. Code 49500 is for children age 5 years or younger.
- 49520Inguinal hernia repairRecurrent, reducible
- Use 49500 for a first-time reducible hernia repair. Code 49520 is for a recurrent reducible inguinal hernia.
- 49650Inguinal hernia repairLaparoscopic, initial
- Code 49500 describes open repair in the age-specific initial-repair family; 49650 is used when the initial inguinal hernia repair is performed laparoscopically.
49500 billing questions
How does this code differ from 49501?
Use 49500 for a reducible hernia in a child age 5 years or younger. Code 49501 is for an incarcerated or strangulated hernia in that age group.
How does this code differ from 49505?
Both describe initial, reducible inguinal hernia repair, but 49500 is for a child age 5 years or younger; 49505 is for the older age group.
Are the day-before visit and routine postoperative visits separately reported?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How should bilateral repairs be reported?
Report bilateral repair with modifier 50. CMS pays this bilateral procedure at 150%.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be available. 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
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