CPT code 49613: Abdominal hernia repair, recurrent, reducible, under 3 cm2026 Medicare rate & RVUs in Washington
Reports repair of a recurrent, reducible anterior abdominal hernia when the total length of the repaired defect or defects is under 3 cm.
CMS doesn’t publish an office rate for 49613 in Washington.
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 49613 covers
This code describes repair of a previously repaired anterior abdominal hernia that is reducible and has a total defect length under 3 cm. These repairs are commonly performed by general surgeons in a hospital or ambulatory surgery setting. The code covers recognized anterior abdominal hernia sites, such as incisional, ventral, umbilical, epigastric, and Spigelian hernias, and includes mesh or other prosthesis implantation when performed. The repair may use an open, laparoscopic, or robotic approach.
Select the code using the hernia’s recurrence status, reducibility, and total length of the defect or defects repaired. The operative report should establish the prior repair, reducibility, measured defect length, and repair performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. 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 49613 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| King County, WA | Unavailable | $406.78 |
| Rest of Washington | Unavailable | $379.83 |
How the 49613 rate is calculated
Each of 49613’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 · 49613
RVUs × geographic indexes × conversion factor
Work7.23
7.23 RVUs× 1.000 GPCI
Practice expense2.50
2.50 RVUs× 1.000 GPCI
Malpractice1.86
1.86 RVUs× 1.000 GPCI
Adjusted RVUs
11.5900
Conversion factor
$33.4009
Medicare rate
$387.12
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49613
The CMS indicators that decide how 49613 is paid alongside other services.
CMS payment indicators · 49613
Abdominal hernia repair, recurrent, reducible, under 3 cm
| 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
49613 without 51 · national facility
$387.12
Abdominal hernia repair, recurrent, reducible, under 3 cm
49613-51 · Second procedure: 50%
$193.56
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%).
49613 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49614Hernia repairRecurrent, under 3 cm
- Both are for recurrent defects under 3 cm. Choose 49613 for a reducible hernia and 49614 for an incarcerated or strangulated hernia.
- 49615Hernia repairRecurrent, 3–10 cm, reducible
- This code is for recurrent, reducible defects under 3 cm; 49615 is for the same recurrence and reducibility status when total defect length is 3–10 cm.
- 49591Hernia repairInitial, under 3 cm, reducible
- Both describe reducible anterior abdominal hernia repair under 3 cm. 49613 is for a recurrent hernia; 49591 is for an initial repair.
49613 billing questions
How is this code distinguished from 49614?
Both describe recurrent anterior abdominal hernia repair for a defect under 3 cm. Use 49613 when the hernia is reducible; 49614 is for an incarcerated or strangulated hernia.
Does the code include mesh placement?
Yes. Mesh or another prosthesis is included in the hernia repair code when implanted during the repair.
What documentation supports the under-3-cm level?
Document the total length of the defect or defects repaired, along with the operative findings that establish recurrence and reducibility.
Should modifier 50 be used for a bilateral repair?
No. Modifier 50 is inappropriate for this code; CMS does not apply a bilateral adjustment to it.
How are other procedures in the same session paid?
CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to the other procedures.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. 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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