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Billing code 49187: Open lesion surgeryMedicare rate & RVUs

Open surgery to excise or destroy an intra-abdominal tumor, cyst, or endometrioma measuring 5.1–10 cm.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,546.46 for 49187 nationally in a facility.

Medicare rate · 49187

Open lesion surgery

Work RVUs
27.93
Total RVUs
46.30
Global days
090

National rate · 2026

$1,546.46

Facility setting, before claim adjustments.

See every locality for 49187 →Billed by an NP, PA or therapist? →

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 49187 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 49187 covers

This code describes open surgical excision or destruction of an intra-abdominal tumor, cyst, or endometrioma in the 5.1–10 cm size band. General surgeons, gynecologic surgeons, or surgical oncologists may perform the service when treating a lesion that requires open access. The code distinguishes this work by the lesion’s size as well as the open approach and treatment performed.

Select the size-level code supported by the documented lesion measurement. The operative report should identify the target and location, the open approach, whether the lesion was excised or destroyed, and its size. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. An assistant at surgery may be paid; co-surgeons require 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 49187 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

49187 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,403.50
Alaska*Unavailable$1,942.57
ArizonaUnavailable$1,503.21
ArkansasUnavailable$1,386.18
AtlantaUnavailable$1,598.75
AustinUnavailable$1,547.03
BakersfieldUnavailable$1,518.66
Baltimore/Surr. CntysUnavailable$1,641.35
BeaumontUnavailable$1,495.31
BrazoriaUnavailable$1,503.16

49187 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
49187 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 49187 rate is calculated

Each of 49187’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 · 49187

RVUs × geographic indexes × conversion factor

Work27.93

27.93 RVUs× 1.000 GPCI

Practice expense11.95

11.95 RVUs× 1.000 GPCI

Malpractice6.42

6.42 RVUs× 1.000 GPCI

Adjusted RVUs

46.3000

Conversion factor

$33.4009

Medicare rate

$1,546.46

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 49187

49187 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 49187

Open lesion surgery

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 · 49187

Open lesion surgery

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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

49187 without 51 · national facility

$1,546.46

Open lesion surgery

49187-51 · Second procedure: 50%

$773.23

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

49187 compared with similar codes

Compare codes · National

5 codes, side by side

  • 49187

    Open lesion surgery27.93 wRVU

    Not priced

  • 49186

    Open lesion removal21.45 wRVU

    Not priced

  • 49188

    Open lesion treatment33.15 wRVU

    Not priced

  • 49180

    Mass biopsy1.69 wRVU

    $170.34

  • 49185

    Fluid collection treatment2.29 wRVU

    $1,206.44

How to choose

49186Open lesion removal
This sibling is for the smaller lesion size band. Use 49187 for a lesion measuring 5.1–10 cm.
49188Open lesion treatment
This sibling is for the next larger lesion size band. Use 49187 when the documented measurement falls within 5.1–10 cm.
49180Mass biopsy
49180 is for biopsy of an abdominal mass; 49187 describes open excision or destruction of a lesion in the specified size band.
49185Fluid collection treatment
49185 describes sclerotherapy of a fluid collection, rather than open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma.

Codes related to 49187

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

Codes related to 49187
CodeHow it relatesNational office range
Same family
49186Open lesion removalSibling code for the smaller lesion size band.No office rate
49188Open lesion treatmentSibling code for the next larger lesion size band.No office rate
49189Open lesion excisionSibling code for a larger lesion size band.No office rate
49190Open lesion surgerySibling code for lesions in the largest size band.No office rate

49187 billing questions

How does 49187 differ from 49186 or 49188?

These are size-level siblings for open treatment of intra-abdominal lesions. Use 49187 when the documented lesion measures 5.1–10 cm; 49186 is the smaller size band and 49188 the next larger band.

Is this code for biopsy of an abdominal mass?

No. 49187 describes open excision or destruction of a lesion in its specified size band. 49180 is the nearby code for biopsy of an abdominal mass.

What operative documentation supports 49187?

Document the lesion’s location and size, the open approach, and whether it was excised or destroyed. The recorded measurement should support the 5.1–10 cm band.

How does the 90-day global period affect billing?

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

How are multiple procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; 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

Show the CMS file lines behind this rate
RVUs for 49187PPRRVU2026_Oct_nonQPP.csv, line 5,776 (RVU26D)

Open CMS sourceHow we calculate rates

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