CPT code 49594: Hernia repair, initial, 3–10 cm, incarcerated2026 Medicare rate & RVUs in Maryland
Repair an initial anterior abdominal wall hernia with a 3–10 cm defect that is incarcerated or strangulated, including mesh placement when performed.
CMS doesn’t publish an office rate for 49594 in Maryland.
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 49594 covers
This code represents repair of an initial anterior abdominal wall hernia, such as a ventral, incisional, umbilical, or epigastric hernia, when the defect measures 3–10 cm and the hernia is incarcerated or strangulated. A surgeon performs the repair, commonly in a hospital or ambulatory surgery center. Mesh implantation, when performed as part of the repair, is included in the service.
Choose the code based on the documented defect length, whether the hernia is reducible or incarcerated/strangulated, and whether the repair is initial rather than recurrent. The operative report should support the site, defect measurement, and nonreducible or strangulated status. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. 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% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeons require 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 49594 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $726.11 |
| Rest of Maryland | Unavailable | $678.86 |
| Washington, DC area | Unavailable | $742.01 |
How the 49594 rate is calculated
Each of 49594’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 · 49594
RVUs × geographic indexes × conversion factor
Work13.12
13.12 RVUs× 1.000 GPCI
Practice expense3.86
3.86 RVUs× 1.000 GPCI
Malpractice3.45
3.45 RVUs× 1.000 GPCI
Adjusted RVUs
20.4300
Conversion factor
$33.4009
Medicare rate
$682.38
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49594
The CMS indicators that decide how 49594 is paid alongside other services.
CMS payment indicators · 49594
Hernia repair, initial, 3–10 cm, incarcerated
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49594 without 51 · national facility
$682.38
Hernia repair, initial, 3–10 cm, incarcerated
49594-51 · Second procedure: 50%
$341.19
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
49594 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49593Abdominal hernia repairInitial, reducible, 3–10 cm
- Both cover initial repair of a 3–10 cm defect. Choose 49594 for an incarcerated or strangulated hernia and 49593 when it is reducible.
- 49592Abdominal hernia repairIncarcerated or strangulated, under 3 cm
- This code covers an initial incarcerated or strangulated hernia with a defect smaller than 3 cm; 49594 is for a 3–10 cm defect.
- 49596Abdominal hernia repairInitial, over 10 cm, incarcerated
- Both cover initial incarcerated or strangulated hernias, but 49596 is for a defect larger than 10 cm.
- 49614Hernia repairRecurrent, under 3 cm
- Use 49614 for a recurrent incarcerated or strangulated anterior abdominal hernia with a 3–10 cm defect; 49594 describes an initial repair.
49594 billing questions
How does 49594 differ from 49593?
Both describe an initial anterior abdominal hernia repair for a 3–10 cm defect. Use 49594 for an incarcerated or strangulated hernia; 49593 is for a reducible hernia.
Is mesh separately reported with 49594?
Mesh implantation performed as part of the hernia repair is included in this service.
What documentation supports 49594?
The operative report should identify the hernia and its reducibility or strangulated status, document the defect measurement, and establish that the repair is initial rather than recurrent.
Does 49594 have a postoperative global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
Can modifier 50 be used for bilateral repair?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and 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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