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Billing code 49190: Open lesion surgeryMedicare rate & RVUs

Reports open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma when its documented size exceeds 30 cm.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $2,640.34 for 49190 nationally in a facility.

Medicare rate · 49190

Open lesion surgery

Swap in your local Medicare rate.

Work RVUs
48.75
Total RVUs
79.05
Global days
090

National rate · 2026

$2,640.34

Facility setting, before claim adjustments.

See every locality for 49190 → · 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 49190 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 49190 covers

This code covers an open operation to remove or destroy an intra-abdominal tumor, cyst, or endometrioma measuring more than 30 cm. A surgeon may perform the procedure through an open abdominal approach in a hospital operating room. The lesion may be benign or malignant; the code’s size tier and open approach distinguish the service, not the lesion’s pathology.

Select this tier using the documented size of the treated lesion; the operative report should support the lesion type, its measurement, and the open excision or destruction performed. The code has a 90-day global period, including 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 others at 50%. An assistant at surgery may be paid. Co-surgeons are paid only with 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 49190 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

49190 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,399.89
Alaska*Unavailable$3,330.74
ArizonaUnavailable$2,567.30
ArkansasUnavailable$2,370.79
AtlantaUnavailable$2,729.64
AustinUnavailable$2,638.87
BakersfieldUnavailable$2,588.86
Baltimore/Surr. CntysUnavailable$2,800.75
BeaumontUnavailable$2,556.26
BrazoriaUnavailable$2,566.45

49190 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
49190 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 49190 rate is calculated

Each of 49190’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 · 49190

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 48.75Practice expense 19.26Malpractice 11.04

79.0500 adjusted RVUs×$33.4009 conversion factor=$2,640.34

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

Payment rules and modifiers for 49190

49190 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 49190

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 · 49190

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.

  • 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

49190 without 51 · national facility

$2,640.34

Open lesion surgery

49190-51 · Second procedure: 50%

$1,320.17

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

49190 compared with similar codes

Compare codes

49190 vs 49189 vs 49188 vs 49180: national Medicare rates

Swap in your local Medicare rate.

  • 49190
    Open lesion surgery · 48.75 wRVU
    —
  • 49189
    Open lesion excision · 39 wRVU
    —
  • 49188
    Open lesion treatment · 33.15 wRVU
    —
  • 49180
    Mass biopsy · 1.69 wRVU
    $170.34

How to choose

49189Open lesion excision
Both describe open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma. Select 49190 for a lesion over 30 cm and 49189 for one measuring 20.1 to 30 cm.
49188Open lesion treatment
49188 is the open excision or destruction tier for lesions measuring 10.1 to 20 cm; 49190 is reserved for lesions over 30 cm.
49180Mass biopsy
49180 describes biopsy sampling of an abdominal mass. Use 49190 when the surgeon performs open excision or destruction of the qualifying large lesion.

Codes related to 49190

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

Codes related to 49190
CodeHow it relatesNational office range
Same family
49189Open lesion excisionOpen excision or destruction of an intra-abdominal lesion measuring 20.1 to 30 cm.No office rate
49188Open lesion treatmentOpen excision or destruction of an intra-abdominal lesion measuring 10.1 to 20 cm.No office rate
49187Open lesion surgeryOpen excision or destruction of an intra-abdominal lesion measuring 5.1 to 10 cm.No office rate
49186Open lesion removalOpen excision or destruction of an intra-abdominal lesion measuring 5 cm or less.No office rate
Used instead
49180Mass biopsyFor biopsy of an abdominal mass when sampling, rather than open excision or destruction, is performed.$152.22–$221.45

49190 billing questions

How is 49190 distinguished from 49189?

49190 is for a treated lesion measuring more than 30 cm. Use 49189 for the 20.1-to-30-cm tier.

Is 49190 appropriate for a biopsy of an abdominal mass?

No. 49190 describes open excision or destruction, while 49180 describes biopsy of an abdominal mass. Choose based on the service actually performed.

What documentation supports the size tier?

The operative report should identify the tumor, cyst, or endometrioma, document its size, and describe the open excision or destruction.

How does the 90-day global period affect postoperative billing?

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

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is submitted; team surgery is not permitted.

What happens when another procedure is performed in the same session?

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

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 49190PPRRVU2026_Oct_nonQPP.csv, line 5,779 (RVU26D)

Open CMS sourceHow we calculate rates

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