CPT code 49650: Inguinal hernia repair, laparoscopic, initial2026 Medicare rate & RVUs in Maryland
Reports laparoscopic repair of an initial inguinal hernia, typically performed by a surgeon to reduce the hernia and reinforce the repair.
CMS doesn’t publish an office rate for 49650 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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On this page 9 sections
What 49650 covers
A surgeon repairs an initial inguinal hernia through small abdominal incisions using a laparoscope and surgical instruments. The surgeon reduces the hernia and repairs the defect, commonly reinforcing the area with mesh. This approach is performed in hospital operating rooms and ambulatory surgery centers; transabdominal preperitoneal and totally extraperitoneal approaches are common. Mesh placement is part of the repair rather than a separate service under this code.
Report this code for laparoscopic repair of an initial, not recurrent, inguinal hernia. The operative report should support the laparoscopic approach, hernia site, and whether the repair is initial or recurrent. For bilateral repair in the same session, CMS pays 150% when modifier 50 is reported. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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 49650 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 | $452.28 |
| Rest of Maryland | Unavailable | $423.75 |
| Washington, DC area | Unavailable | $470.48 |
How the 49650 rate is calculated
Each of 49650’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 · 49650
RVUs × geographic indexes × conversion factor
Work6.20
6.20 RVUs× 1.000 GPCI
Practice expense4.87
4.87 RVUs× 1.000 GPCI
Malpractice1.63
1.63 RVUs× 1.000 GPCI
Adjusted RVUs
12.7000
Conversion factor
$33.4009
Medicare rate
$424.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49650
49650 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49650
Inguinal hernia repair, laparoscopic, initial
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49650
Inguinal hernia repair, laparoscopic, initial
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
49650 without 50 · national facility
$424.19
Inguinal hernia repair, laparoscopic, initial
49650-50 · Bilateral: 150%
$636.29
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
49650 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49651Inguinal hernia repairLaparoscopic, recurrent
- Both describe laparoscopic inguinal hernia repair; use 49651 for recurrent hernias and 49650 for initial repairs.
- 49505Inguinal hernia repairInitial, reducible, age 5+
- This is an open repair of an initial inguinal hernia. Use 49650 when the repair is performed laparoscopically.
- 49507Inguinal hernia repairInitial, incarcerated, age 5+
- This is an open repair of an incarcerated or strangulated initial inguinal hernia; 49650 identifies laparoscopic initial repair.
49650 billing questions
When should 49651 be reported instead?
Report 49651 for laparoscopic repair of a recurrent inguinal hernia. Code 49650 is for an initial repair.
Is mesh separately reported with 49650?
Mesh used to reinforce the laparoscopic inguinal repair is included in the repair service; do not report it as a separate mesh service.
How is bilateral repair reported?
For repair of both sides in the same session, report modifier 50. CMS pays the bilateral procedure at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; CMS does not permit team surgery for this code.
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
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