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

Repair of an initial, reducible anterior abdominal wall hernia with total defect length over 10 cm, regardless of open, laparoscopic, or robotic approach.

CMS RVU26DEffective Oct 1, 2026One payment locality5.3K Medicare services in 2024

In Nebraska, Medicare pays $621.97 for 49595 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$621.97Hospital or facility

Check a contract rate as a % of Medicare · 49595 nationwide

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

We’ll open 49595 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Nebraska
  2. What 49595 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Nebraska compares for 49595

Across 109 of 109 payment localities, the facility rate for 49595 runs from $618.57 in Wisconsin to $888.09 in Alaska. Nebraska pays $621.97. The RVUs are the same everywhere; the geographic indexes change the dollars.

49595 in Nebraska vs other payment areas
  1. Nebraska · this page$621.97
  2. Los Angeles, CA · California$708.73+$86.76
  3. Washington, DC area · District of Columbia$765.99+$144.02
  4. Miami, FL · Florida$887.16+$265.19
  5. Chicago, IL · Illinois$858.37+$236.40
  6. Manhattan, NY · New York$823.20+$201.23
  7. Alaska · Alaska$888.09+$266.12

Other areas in Nebraska first, then benchmark localities. Bars start at $0.

Every other payment area

49595 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama—$637.30
ArkansasArkansas—$629.23
ArizonaArizona—$683.56
Bakersfield, CACalifornia—$680.65
Chico, CACalifornia—$671.29
El Centro, CACalifornia—$671.87
Fresno, CACalifornia—$671.29
Hanford, CACalifornia—$671.29

49595 rates by state

Office rate range in each state. Select a state to see its payment localities.

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
49595 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

See 49595 in every payment locality

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.

How the rate is built · 49595

RVUs × geographic indexes × conversion factor

Office or facility?

Work13.59

13.59 RVUs× 1.000 GPCI

Practice expense4.03

4.03 RVUs× 1.000 GPCI

Malpractice3.47

3.47 RVUs× 1.000 GPCI

Adjusted RVUs

21.0900

Conversion factor

$33.4009

Medicare rate

$704.42

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Nebraska inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,841

Code
49595
Physician work
13.59
Practice expense
4.03
Malpractice
3.47

GPCI2026.csv

72

Locality
Nebraska
Physician work
1.000
Practice expense
0.923
Malpractice
0.378
Facility calculation for 49595 in Nebraska
ComponentRVULocality factorAdjusted
Physician work13.59× 1.00013.5900
Practice expense4.03× 0.9233.7197
Malpractice3.47× 0.3781.3117
Total RVUs18.6213
Conversion factor× 33.4009

Facility rate, Nebraska$621.97

Facility: (13.59 × 1 + 4.03 × 0.923 + 3.47 × 0.378) × $33.4009 = $621.97

Open 49595 in the RVU calculator

Payment rules and modifiers for 49595

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

CMS payment indicators · 49595

Abdominal hernia repair, initial, over 10 cm, reducible

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

49595 without 51 · national facility

$704.42

Abdominal hernia repair, initial, over 10 cm, reducible

49595-51 · Second procedure: 50%

$352.21

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%).

When to use modifier 51

How 49595 has changed in Nebraska

49595 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
  1. January 1, 2023

    RVU23A

    No ratechanged toNo rate

    Held through RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D, RVU26A, RVU26B, RVU26C, RVU26D.

  2. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$621.97RVU26D
2026-07-01Not available in this setting$621.97RVU26C
2026-04-01Not available in this setting$621.97RVU26B
2026-01-01Not available in this setting$621.97RVU26A
2025-10-01Not available in this setting$659.54RVU25D
2025-07-01Not available in this setting$659.54RVU25C
2025-04-01Not available in this setting$659.54RVU25B
2025-01-01Not available in this setting$659.54RVU25A
2024-10-01Not available in this setting$672.32RVU24D
2024-07-01Not available in this setting$672.32RVU24C
2024-04-01Not available in this setting$672.32RVU24B
2024-03-09Not available in this setting$672.32RVU24AR
2024-01-01Not available in this setting$661.35RVU24A
2023-10-01Not available in this setting$679.10RVU23D
2023-07-01Not available in this setting$679.10RVU23C
2023-04-01Not available in this setting$679.10RVU23B
2023-01-01Not available in this setting$679.10RVU23A
2022-10-01Not in this releaseNot in this releaseRVU22D
2022-07-01Not in this releaseNot in this releaseRVU22C
2022-04-01Not in this releaseNot in this releaseRVU22B
2022-01-01Not in this releaseNot in this releaseRVU22A
2021-10-01Not in this releaseNot in this releaseRVU21D
2021-07-01Not in this releaseNot in this releaseRVU21C
2021-04-01Not in this releaseNot in this releaseRVU21B
2021-01-01Not in this releaseNot in this releaseRVU21A
2020-10-01Not in this releaseNot in this releaseRVU20D
2020-07-01Not in this releaseNot in this releaseRVU20C
2020-04-01Not in this releaseNot in this releaseRVU20B
2020-01-01Not in this releaseNot in this releaseRVU20A
2019-10-01Not in this releaseNot in this releaseRVU19D
2019-07-01Not in this releaseNot in this releaseRVU19C
2019-04-01Not in this releaseNot in this releaseRVU19B
2019-01-01Not in this releaseNot in this releaseRVU19A
2018-10-01Not in this releaseNot in this releaseRVU18D
2018-07-01Not in this releaseNot in this releaseRVU18C
2018-04-01Not in this releaseNot in this releaseRVU18B
2018-01-01Not in this releaseNot in this releaseRVU18AR1
2017-10-01Not in this releaseNot in this releaseRVU17D
2017-07-01Not in this releaseNot in this releaseRVU17C
2017-04-01Not in this releaseNot in this releaseRVU17B
2017-01-01Not in this releaseNot in this releaseRVU17A
2016-10-01Not in this releaseNot in this releaseRVU16D
2016-07-01Not in this releaseNot in this releaseRVU16C
2016-04-01Not in this releaseNot in this releaseRVU16B
2016-01-01Not in this releaseNot in this releaseRVU16A
2015-10-01Not in this releaseNot in this releaseRVU15D
2015-07-01Not in this releaseNot in this releaseRVU15C
2015-04-01Not in this releaseNot in this releaseRVU15B
2015-01-01Not in this releaseNot in this releaseRVU15A
2014-10-01Not in this releaseNot in this releaseRVU14D
2014-07-01Not in this releaseNot in this releaseRVU14C
2014-04-01Not in this releaseNot in this releaseRVU14B
2014-01-01Not in this releaseNot in this releaseRVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 49595 for an earlier date of service

Where the Nebraska rate applies

Nebraska is a Medicare payment area, not a city. Our Census mapping connects it to 593 cities and communities in Nebraska. Some span more than one payment area; confirm with the service ZIP.

  • Abie
  • Adams
  • Agnew
  • Ainsworth
  • Albion
  • Alda
  • Alexandria
  • Allen

Browse all communities in Nebraska

49595 billing questions

How is 49595 distinguished from 49593?

49595 is for a total defect length over 10 cm. 49593 applies when the total length is 3 cm through 10 cm and the hernia is reducible.

When should 49596 be used instead?

Use 49596 for an initial anterior abdominal hernia over 10 cm that is nonreducible or strangulated. 49595 is for a reducible hernia in that size category.

Does the surgical approach change code selection?

No. The code covers open, laparoscopic, and robotic repair; select it based on initial versus recurrent status, reducibility, and total defect length.

Can mesh placement be billed separately?

Mesh or other prosthetic reinforcement used as part of the hernia repair is included in the service represented by 49595.

What should the operative note document?

Document that the repair is initial, that the hernia is reducible, and the total measured length of the defect or defects.

How are assistant and co-surgeon services handled?

An assistant at surgery may be paid. 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

Show the CMS file lines behind this rate
RVUs for 49595PPRRVU2026_Oct_nonQPP.csv, line 5,841 (RVU26D)
Geographic factors for NebraskaGPCI2026.csv, line 72 (RVU26D)

Open CMS sourceHow we calculate rates

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