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Billing code 49496: Inguinal hernia repairMedicare rate & RVUs

Repair of an initial incarcerated or strangulated inguinal hernia in a full-term infant younger than 6 months, with or without hydrocele treatment.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $596.21 for 49496 nationally in a facility.

Medicare rate · 49496

Inguinal hernia repair

Swap in your local Medicare rate.

Work RVUs
9.18
Total RVUs
17.85
Global days
090

National rate · 2026

$596.21

Facility setting, before claim adjustments.

See every locality for 49496 → · 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 49496 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 49496 covers

This code represents operative repair of an initial inguinal hernia in a full-term infant younger than 6 months when the hernia is incarcerated or strangulated. A pediatric or general surgeon typically performs the repair in an operating room. The code includes the repair whether or not a hydrocele is treated during the same procedure. It is not the reducible-hernia code for this infant group, nor the code for a preterm infant or an older child.

The operative report should support the infant’s age and full-term status, that the hernia is initial, and the finding of incarceration or strangulation; document the side or sides repaired. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral repair with modifier 50 is paid at 150%. 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 49496 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

49496 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$534.62
Alaska*Unavailable$726.11
ArizonaUnavailable$577.94
ArkansasUnavailable$527.11
AtlantaUnavailable$616.96
AustinUnavailable$599.48
BakersfieldUnavailable$589.82
Baltimore/Surr. CntysUnavailable$635.73
BeaumontUnavailable$571.70
BrazoriaUnavailable$578.72

49496 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
49496 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 49496 rate is calculated

Each of 49496’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 · 49496

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 9.18Practice expense 6.21Malpractice 2.46

17.8500 adjusted RVUs×$33.4009 conversion factor=$596.21

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

Payment rules and modifiers for 49496

49496 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 49496

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 · 49496

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

49496 without 50 · national facility

$596.21

Inguinal hernia repair

49496-50 · Bilateral: 150%

$894.32

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

49496 compared with similar codes

Compare codes

49496 vs 49495 vs 49492 vs 49501: national Medicare rates

Swap in your local Medicare rate.

  • 49496
    Inguinal hernia repair · 9.18 wRVU
    —
  • 49495
    Hernia repair · 6.05 wRVU
    —
  • 49492
    Inguinal hernia repair · 15.04 wRVU
    —
  • 49501
    Inguinal hernia repair · 9.13 wRVU
    —

How to choose

49495Hernia repair
Both codes are for initial hernia repair in a full-term infant younger than 6 months. Choose 49496 for an incarcerated or strangulated hernia and 49495 for a reducible one.
49492Inguinal hernia repair
This code is for a full-term infant younger than 6 months; 49492 is for a preterm infant with an incarcerated or strangulated hernia.
49501Inguinal hernia repair
Both address an incarcerated or strangulated initial hernia, but 49501 is for a child age 6 months to younger than 5 years.

Codes related to 49496

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

Codes related to 49496
CodeHow it relatesNational office range
Same family
49495Hernia repairInitial repair for a reducible hernia in a full-term infant younger than 6 months.No office rate
49492Inguinal hernia repairIncarcerated or strangulated initial repair for a preterm infant.No office rate
49491Inguinal hernia repairReducible initial hernia repair for a preterm infant.No office rate
Used instead
49501Inguinal hernia repairIncarcerated or strangulated initial repair for a child age 6 months to younger than 5 years.No office rate
49507Inguinal hernia repairIncarcerated or strangulated initial repair for a patient age 5 years or older.No office rate

49496 billing questions

How do I distinguish this code from 49495?

Use 49496 when the initial hernia is incarcerated or strangulated. Code 49495 is for a reducible hernia in the same full-term infant age group.

Does the code include hydrocele treatment performed with the repair?

Yes. This repair code covers the service whether or not a hydrocele is treated during the same operation.

What documentation supports reporting 49496?

Document the infant’s age and full-term status, that this is an initial hernia, the operative finding of incarceration or strangulation, and the side repaired.

How is a bilateral repair reported?

When both sides are repaired, report modifier 50; CMS pays the bilateral procedure at 150%.

What postoperative care is included?

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

Can an assistant or co-surgeon be paid?

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 49496PPRRVU2026_Oct_nonQPP.csv, line 5,824 (RVU26D)

Open CMS sourceHow we calculate rates

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