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Billing code 49492: Inguinal hernia repairMedicare rate & RVUs

Reports initial repair of an incarcerated or strangulated inguinal hernia in a preterm infant meeting the code’s gestational and postconceptional age criteria.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $911.18 for 49492 nationally in a facility.

Medicare rate · 49492

Inguinal hernia repair

Swap in your local Medicare rate.

Work RVUs
15.04
Total RVUs
27.28
Global days
090

National rate · 2026

$911.18

Facility setting, before claim adjustments.

See every locality for 49492 → · 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 49492 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 49492 covers

This code describes initial surgical repair of an inguinal hernia that is incarcerated or strangulated in a preterm infant: born before 37 weeks’ gestation and operated on from birth through 50 weeks’ postconceptional age. A pediatric or general surgeon typically performs the repair in an operating room, addressing the hernia and its contents. The code’s age and prematurity criteria distinguish it from infant hernia repairs for other patient groups.

Report it when the operative record supports the qualifying birth gestation, the infant’s postconceptional age on the procedure date, and an incarcerated or strangulated hernia. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral repair, modifier 50 is paid at 150%; when multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. 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 49492 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

49492 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$818.58
Alaska*Unavailable$1,119.91
ArizonaUnavailable$883.33
ArkansasUnavailable$807.34
AtlantaUnavailable$944.07
AustinUnavailable$912.80
BakersfieldUnavailable$894.58
Baltimore/Surr. CntysUnavailable$971.08
BeaumontUnavailable$876.93
BrazoriaUnavailable$883.18

49492 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
49492 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 49492 rate is calculated

Each of 49492’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 · 49492

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 15.04Practice expense 8.22Malpractice 4.02

27.2800 adjusted RVUs×$33.4009 conversion factor=$911.18

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

Payment rules and modifiers for 49492

49492 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 49492

Inguinal hernia repair

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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
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 · 49492

Inguinal hernia repair

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 50 · payment effect

With and without the modifier

49492 without 50 · national facility

$911.18

Inguinal hernia repair

49492-50 · Bilateral: 150%

$1,366.77

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).

When to use modifier 50

49492 compared with similar codes

Compare codes

49492 vs 49491 vs 49495 vs 49496: national Medicare rates

Swap in your local Medicare rate.

  • 49492
    Inguinal hernia repair · 15.04 wRVU
    —
  • 49491
    Inguinal hernia repair · 12.22 wRVU
    —
  • 49495
    Hernia repair · 6.05 wRVU
    —
  • 49496
    Inguinal hernia repair · 9.18 wRVU
    —

How to choose

49491Inguinal hernia repair
Choose 49491 when the hernia is reducible. 49492 identifies an incarcerated or strangulated hernia in a qualifying preterm infant.
49495Hernia repair
49495 is for a reducible hernia in an infant younger than 6 months. 49492 requires the preterm-infant criteria and an incarcerated or strangulated hernia.
49496Inguinal hernia repair
49496 covers an incarcerated or strangulated hernia in an infant younger than 6 months; 49492 is distinguished by its preterm birth and postconceptional-age criteria.

Codes related to 49492

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

Codes related to 49492
CodeHow it relatesNational office range
Same family
49491Inguinal hernia repairPreterm-infant counterpart for a reducible inguinal hernia.No office rate
Used instead
49495Hernia repairReducible inguinal hernia repair for an infant younger than 6 months.No office rate
49496Inguinal hernia repairIncarcerated or strangulated inguinal hernia repair for an infant younger than 6 months.No office rate

49492 billing questions

When should 49492 be chosen instead of 49491?

Use 49492 for an incarcerated or strangulated hernia; 49491 is for a reducible hernia. Both require the specified preterm birth and postconceptional age criteria.

How does 49492 differ from 49496?

49492 is for a qualifying preterm infant operated on through 50 weeks’ postconceptional age. 49496 is the incarcerated or strangulated repair code for an infant younger than 6 months without that specific preterm-infant definition.

What documentation supports reporting 49492?

Document gestational age at birth, age on the operation date in postconceptional weeks, and the operative finding of incarceration or strangulation.

How is a bilateral repair reported?

Report modifier 50 for bilateral repair; CMS pays the bilateral procedure at 150%.

Are assistant or co-surgeon services payable with 49492?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; 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 49492PPRRVU2026_Oct_nonQPP.csv, line 5,822 (RVU26D)

Open CMS sourceHow we calculate rates

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