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Billing code 49189: Open lesion excisionMedicare rate & RVUs

Open abdominal excision or destruction of a 20.1-30 cm intra-abdominal tumor, cyst, or endometrioma is reported when operative treatment targets a lesion in this size band.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $2,147.34 for 49189 nationally in a facility.

Medicare rate · 49189

Open lesion excision

Work RVUs
39
Total RVUs
64.29
Global days
090

National rate · 2026

$2,147.34

Facility setting, before claim adjustments.

See every locality for 49189 →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 49189 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 49189 covers

This code describes open operative treatment by excision or destruction of a large intra-abdominal tumor, cyst, or endometrioma in the 20.1-30 cm size band. General surgeons, gynecologic surgeons, and surgical oncologists may perform the service in a hospital operating room. The operative report should establish the open approach, the lesion treated, the method of treatment, and its documented size.

Choose this level based on the treated lesion’s size; use a neighboring code when it falls in another size band. 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 other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is not appropriate for this code. 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 49189 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

49189 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,948.87
Alaska*Unavailable$2,699.05
ArizonaUnavailable$2,087.19
ArkansasUnavailable$1,924.83
AtlantaUnavailable$2,220.38
AustinUnavailable$2,147.24
BakersfieldUnavailable$2,106.79
Baltimore/Surr. CntysUnavailable$2,279.15
BeaumontUnavailable$2,077.03
BrazoriaUnavailable$2,086.73

49189 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
49189 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 49189 rate is calculated

Each of 49189’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 · 49189

RVUs × geographic indexes × conversion factor

Work39.00

39.00 RVUs× 1.000 GPCI

Practice expense16.29

16.29 RVUs× 1.000 GPCI

Malpractice9.00

9.00 RVUs× 1.000 GPCI

Adjusted RVUs

64.2900

Conversion factor

$33.4009

Medicare rate

$2,147.34

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

Payment rules and modifiers for 49189

49189 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 49189

Open lesion excision

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 · 49189

Open lesion excision

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

49189 without 51 · national facility

$2,147.34

Open lesion excision

49189-51 · Second procedure: 50%

$1,073.67

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

49189 compared with similar codes

Compare codes · National

5 codes, side by side

  • 49189

    Open lesion excision39 wRVU

    Not priced

  • 49188

    Open lesion treatment33.15 wRVU

    Not priced

  • 49190

    Open lesion surgery48.75 wRVU

    Not priced

  • 49180

    Mass biopsy1.69 wRVU

    $170.34

  • 49185

    Fluid collection treatment2.29 wRVU

    $1,206.44

How to choose

49188Open lesion treatment
49188 is for an open-treated intra-abdominal lesion measuring 10.1-20 cm; this code is for the next size band, 20.1-30 cm.
49190Open lesion surgery
49190 applies when the lesion is larger than 30 cm. Use this code for the 20.1-30 cm band.
49180Mass biopsy
49180 is for biopsy of an abdominal mass. This code describes open excision or destruction, not tissue sampling alone.
49185Fluid collection treatment
49185 describes sclerotherapy of a fluid collection. This code describes open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma.

Codes related to 49189

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

Codes related to 49189
CodeHow it relatesNational office range
Same family
49188Open lesion treatmentSame open intra-abdominal lesion excision or destruction family; covers the 10.1-20 cm size band.No office rate
49190Open lesion surgerySame family for lesions larger than 30 cm.No office rate
49187Open lesion surgerySame family for lesions in the 5.1-10 cm size band.No office rate
49186Open lesion removalSame family for lesions 5 cm or smaller.No office rate

49189 billing questions

How is this code distinguished from 49188 or 49190?

Use this code when the treated lesion measures 20.1-30 cm. Code 49188 covers the smaller 10.1-20 cm band, while 49190 is for lesions larger than 30 cm.

Can 49180 be reported for the same lesion?

49180 describes biopsy of an abdominal mass, while this code describes open excision or destruction. Report both only when the record supports distinct services rather than treating the same operative work as both sampling and definitive treatment.

Should modifier 50 be appended for bilateral disease?

No. The code’s descriptor and anatomy do not support modifier 50.

Can an assistant or co-surgeon be reported?

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

What documentation supports the size-level selection?

Document the open approach, the tumor, cyst, or endometrioma treated, the treatment performed, and the lesion’s size supporting the 20.1-30 cm band.

What postoperative care is included?

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

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 49189PPRRVU2026_Oct_nonQPP.csv, line 5,778 (RVU26D)

Open CMS sourceHow we calculate rates

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