CPT code 49616: Hernia repair, recurrent, 3-10 cm, incarcerated2026 Medicare rate & RVUs

Medicare pays $783.25 for 49616 nationally in a facility.

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

What 49616 covers

Code 49616 represents operative repair of a recurrent anterior abdominal wall hernia with a total defect length from 3 through 10 cm when the hernia is incarcerated or strangulated. Relevant sites include ventral, incisional, umbilical, epigastric, and Spigelian hernias. General surgeons typically perform the repair in an operating room using open, laparoscopic, or robotic access; the code covers the approach and mesh placement when performed.

Select the code based on recurrence at the repaired site, incarceration or strangulation status, and the total length of the defect or defects repaired—not the incision length or access method. The operative report should document the prior repair, clinical findings establishing incarceration or strangulation, defect measurements, and the repair performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Assistant-at-surgery payment may be made; 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 49616 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

49616 rates by state

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

How the 49616 rate is calculated

Each of 49616’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 49616

The CMS indicators that decide how 49616 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

49616 compared with similar codes

How to choose

49615Hernia repairRecurrent, 3–10 cm, reducible

Use 49615 for a recurrent 3-to-10-cm defect when reducible. Use 49616 when the hernia is incarcerated or strangulated.

49614Hernia repairRecurrent, under 3 cm

Both codes cover recurrent incarcerated or strangulated hernias; 49614 is for a defect under 3 cm, while 49616 is for 3 through 10 cm.

49618Abdominal hernia repairRecurrent, over 10 cm

Both codes cover recurrent incarcerated or strangulated hernias; 49618 is for a defect over 10 cm, while 49616 is for 3 through 10 cm.

49617Abdominal hernia repairRecurrent, over 10 cm, reducible

Both codes cover recurrent 3-to-10-cm defects. Use 49617 when reducible and 49616 when incarcerated or strangulated.

Codes related to 49616

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