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CPT 49186: Open lesion removalMedicare rate & RVUs

Reports open removal or destruction of intra-abdominal tumors, cysts, or endometriomas when the largest treated tumor measures 5 cm or less.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,221.47 for 49186 nationally in a facility.

Medicare rate · 49186

Open lesion removal

Swap in your local Medicare rate.

Work RVUs
21.45
Total RVUs
36.57
Global days
090

National rate · 2026

$1,221.47

Facility setting, before claim adjustments.

See every locality for 49186 →

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

On this page 10 sections
  1. Medicare rate
  2. What 49186 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 49186 covers

The surgeon uses an open abdominal approach to remove or destroy one or more intra-abdominal tumors, cysts, or endometriomas when the largest treated tumor measures 5 cm or less. General surgeons, gynecologic surgeons, and surgical oncologists may perform this service during an operation for a known lesion or disease requiring surgical treatment. Select the size level by the largest tumor, not by adding the diameters of multiple lesions.

The operative report should identify the lesion or lesions, the largest tumor's dimensions, the open approach, and whether the surgeon excised or destroyed the target. CMS assigns a 90-day major-surgery global: the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this descriptor and anatomy. 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.

Where 49186 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

49186 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,108.39
Alaska*Unavailable$1,529.43
ArizonaUnavailable$1,187.55
ArkansasUnavailable$1,094.65
AtlantaUnavailable$1,261.61
AustinUnavailable$1,224.39
BakersfieldUnavailable$1,204.84
Baltimore/Surr. CntysUnavailable$1,296.31
BeaumontUnavailable$1,179.09
BrazoriaUnavailable$1,188.55

49186 rates by state

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

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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
49186 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

How the 49186 rate is calculated

Each of 49186’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 · 49186

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 21.45Practice expense 10.28Malpractice 4.84

36.5700 adjusted RVUs×$33.4009 conversion factor=$1,221.47

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 49186

49186 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 49186

Open lesion removal

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are 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.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 49186

Open lesion removal

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

49186 without 51 · national facility

$1,221.47

Open lesion removal

49186-51 · Second procedure: 50%

$610.74

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

49186 compared with similar codes

Compare codes

49186 vs 49187 vs 49180 vs 49185: national Medicare rates

Swap in your local Medicare rate.

  • 49186
    Open lesion removal · 21.45 wRVU
    —
  • 49187
    Open lesion surgery · 27.93 wRVU
    —
  • 49180
    Mass biopsy · 1.69 wRVU
    $170.34
  • 49185
    Fluid collection treatment · 2.29 wRVU
    $1,206.44

How to choose

49187Open lesion surgery
Both describe open excision or destruction of intra-abdominal tumors, cysts, or endometriomas. Use 49187 when the largest tumor is 5.1–10 cm.
49180Mass biopsy
49180 is percutaneous needle biopsy for tissue sampling; 49186 is open surgical removal or destruction.
49185Fluid collection treatment
49185 is sclerotherapy for a fluid collection. It is not open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma.

Codes related to 49186

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 49186
CodeHow it relatesNational office range
Same family
49187Open lesion surgeryOpen excision or destruction when the largest tumor measures 5.1–10 cm.No office rate
49188Open lesion treatmentOpen excision or destruction when the largest tumor measures 10.1–20 cm.No office rate
49189Open lesion excisionOpen excision or destruction when the largest tumor measures 20.1–30 cm.No office rate
49190Open lesion surgeryOpen excision or destruction when the largest tumor measures more than 30 cm.No office rate
Used instead
49180Mass biopsyPercutaneous needle biopsy for diagnostic sampling of an abdominal or retroperitoneal mass.$152.22–$221.45

49186 billing questions

How is the size level selected when multiple lesions are treated?

Use the largest tumor's measurement; do not total the diameters of separate lesions. The operative report should document that measurement.

When would 49180 be reported instead?

49180 describes percutaneous needle biopsy of an abdominal or retroperitoneal mass. This code describes open excision or destruction, rather than needle sampling.

Can this code be reported for more than one lesion?

Yes. The code covers one or more treated lesions, with the size level determined by the largest tumor.

How does the 90-day global affect related postoperative care?

The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period.

Can an assistant or co-surgeon be billed?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team-surgery billing is not permitted.

Should modifier 50 be used for lesions on both sides?

No. Modifier 50 is inappropriate for this descriptor and anatomy.

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 49186PPRRVU2026_Oct_nonQPP.csv, line 5,775 (RVU26D)

Open CMS sourceHow we calculate rates

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