CPT code 49659: Laparoscopic hernia procedure, unlisted service2026 Medicare rate & RVUs in Illinois
Reports a laparoscopic hernia operation when no specific CPT code describes the procedure performed, with Medicare payment determined by the contractor.
CMS doesn’t publish an office rate for 49659 in Illinois.
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 49659 covers
49659 is an unlisted laparoscopic code for a hernia operation that has no dedicated CPT code matching the procedure performed. A surgeon may report it for laparoscopic hernia repair when the anatomy and work do not fit a more specific listed code. It is used for operative treatment, typically in a hospital or ambulatory surgery setting. The operative report should identify the hernia site, laparoscopic approach, work performed, and why a named code does not represent the service.
For Medicare, status C means CMS publishes no national physician fee schedule payment; the Medicare Administrative Contractor sets payment for each claim and determines the global period. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 invokes the bilateral payment rule. Include a clear operative narrative to support the unlisted service and contractor review.
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 49659 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | Unavailable |
| East St. Louis, IL | Unavailable | Unavailable |
| Rest of Illinois | Unavailable | Unavailable |
| Suburban Chicago, IL | Unavailable | Unavailable |
How the 49659 rate is calculated
Each of 49659’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 · 49659
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49659
The CMS indicators that decide how 49659 is paid alongside other services.
CMS payment indicators · 49659
Laparoscopic hernia procedure, unlisted service
| Rule | CMS value | What it means |
|---|---|---|
| Global period | YYY | The Medicare contractor sets the global period. |
| 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) | 1 | Permitted with supporting documentation. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
49659 without 50 · national facility
$0.00
Laparoscopic hernia procedure, unlisted service
49659-50 · Bilateral: 150%
$0.00
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).
49659 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49650Inguinal hernia repairLaparoscopic, initial
- 49650 describes an initial laparoscopic inguinal hernia repair. Choose 49659 only when the procedure performed is not represented by a specific listed code.
- 49651Inguinal hernia repairLaparoscopic, recurrent
- 49651 describes a recurrent laparoscopic inguinal hernia repair. It is the listed choice when that specific service is performed.
- 49613Abdominal hernia repairRecurrent, reducible, under 3 cm
- 49613 identifies a qualifying recurrent anterior abdominal hernia repair with a reducible defect under 3 cm. Use the specific code when the repair meets its criteria rather than reporting an unlisted service.
- 49615Hernia repairRecurrent, 3–10 cm, reducible
- 49615 identifies a qualifying recurrent anterior abdominal hernia repair with a reducible defect from 3 to 10 cm. Use it when applicable; 49659 is for a procedure without a fitting specific code.
49659 billing questions
When should 49659 be used instead of 49650?
Use 49650 for a listed initial laparoscopic inguinal hernia repair. Use 49659 only when no specific CPT code describes the laparoscopic hernia procedure performed.
What should the operative documentation include?
Describe the hernia site, laparoscopic approach, repair performed, and relevant operative work. Explain why a specific listed code does not represent the procedure.
How does Medicare price 49659?
Status C means there is no national physician fee schedule payment; the Medicare Administrative Contractor sets payment for each claim.
How are bilateral procedures and multiple procedures treated?
Modifier 50 invokes the bilateral payment rule. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard reduction.
Who sets the global period?
The Medicare contractor sets the global period 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
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