CPT code 49595: Abdominal hernia repair, initial, over 10 cm, reducible2026 Medicare rate & RVUs in California

CMS doesn’t publish an office rate for 49595 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 49595 covers

49595 represents operative repair of an initial anterior abdominal wall hernia when the total length of the defect or defects exceeds 10 cm and the hernia is reducible. The category includes ventral, incisional, umbilical, epigastric, and Spigelian hernias. The code covers open, laparoscopic, and robotic repair, so the approach does not determine code selection. Surgeons commonly perform this repair in hospital or ambulatory surgery settings; mesh or other prosthetic reinforcement, when used as part of the repair, is included in the service.

Select the code using the total defect length, reducibility, and whether the repair is initial rather than recurrent. The operative report should support those details, including the measured defect length. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures subject to the standard reduction are performed in one session, the highest-valued procedure is paid in full and the others at 50%. 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 49595 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 49595 rate is calculated

Each of 49595’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 49595

The CMS indicators that decide how 49595 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

49595 compared with similar codes

How to choose

49593Abdominal hernia repairInitial, reducible, 3–10 cm

Both describe initial, reducible anterior abdominal hernia repair. Choose 49593 for total defect length from 3 cm through 10 cm; 49595 is for a length over 10 cm.

49594Hernia repairInitial, 3–10 cm, incarcerated

49594 covers a nonreducible or strangulated initial hernia measuring 3 cm through 10 cm. 49595 is reducible and over 10 cm.

49596Abdominal hernia repairInitial, over 10 cm, incarcerated

Both apply to an initial repair over 10 cm. Use 49595 when the hernia is reducible and 49596 when it is nonreducible or strangulated.

49617Abdominal hernia repairRecurrent, over 10 cm, reducible

49617 is for a recurrent reducible anterior abdominal hernia over 10 cm; 49595 is for an initial repair with the same size and reducibility.

Codes related to 49595

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