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Billing code 49540: Hernia repairMedicare rate & RVUs

Reports operative repair of a lumbar hernia in the posterolateral abdominal wall, rather than a groin or anterior abdominal wall hernia.

CMS RVU26DEffective Oct 1, 2026109 payment localities171 Medicare services in 2024

Medicare pays $643.64 for 49540 nationally in a facility.

Medicare rate · 49540

Hernia repair

Work RVUs
10.47
Total RVUs
19.27
Global days
090

National rate · 2026

$643.64

Facility setting, before claim adjustments.

See every locality for 49540 →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 49540 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 49540 covers

Code 49540 represents operative repair of a lumbar hernia, a defect in the posterolateral abdominal wall that may present as a flank bulge. A surgeon, commonly a general surgeon, performs the repair in an operating room, addressing the defect and any protruding tissue before closing or reinforcing the abdominal wall. The lumbar location distinguishes this service from groin and anterior abdominal wall hernia repairs.

Select the code based on the documented hernia site. The operative report should identify the lumbar location, side, defect, and repair performed. If both sides are repaired in the same session, modifier 50 invokes CMS bilateral payment at 150%. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and the 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 49540 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

49540 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$579.03
Alaska*Unavailable$791.24
ArizonaUnavailable$624.33
ArkansasUnavailable$571.17
AtlantaUnavailable$666.07
AustinUnavailable$645.87
BakersfieldUnavailable$634.58
Baltimore/Surr. CntysUnavailable$685.48
BeaumontUnavailable$618.90
BrazoriaUnavailable$624.76

49540 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
49540 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 49540 rate is calculated

Each of 49540’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 · 49540

RVUs × geographic indexes × conversion factor

Work10.47

10.47 RVUs× 1.000 GPCI

Practice expense6.10

6.10 RVUs× 1.000 GPCI

Malpractice2.70

2.70 RVUs× 1.000 GPCI

Adjusted RVUs

19.2700

Conversion factor

$33.4009

Medicare rate

$643.64

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

Payment rules and modifiers for 49540

49540 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 49540

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 · 49540

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.

  • 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 50 · payment effect

With and without the modifier

49540 without 50 · national facility

$643.64

Hernia repair

49540-50 · Bilateral: 150%

$965.46

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

49540 compared with similar codes

Compare codes · National

4 codes, side by side

  • 49540

    Hernia repair10.47 wRVU

    Not priced

  • 49591

    Hernia repair5.81 wRVU

    Not priced

  • 49505

    Inguinal hernia repair7.76 wRVU

    Not priced

  • 49550

    Femoral hernia repair8.77 wRVU

    Not priced

How to choose

49591Hernia repair
This code addresses an initial, reducible anterior abdominal hernia 3 cm or smaller. Code 49540 is for a hernia in the lumbar, posterolateral abdominal wall.
49505Inguinal hernia repair
This code is for an initial inguinal hernia repair in a patient older than 5 years. Code 49540 applies to the lumbar abdominal wall, not the groin.
49550Femoral hernia repair
This code repairs an initial femoral hernia. Choose 49540 only when the documented hernia is lumbar rather than in the femoral region.

Codes related to 49540

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

Codes related to 49540
CodeHow it relatesNational office range
Used instead
49591Hernia repairFor an initial, reducible anterior abdominal hernia 3 cm or smaller, rather than a lumbar hernia.No office rate
49593Abdominal hernia repairFor an initial, reducible anterior abdominal hernia measuring 3 to 10 cm.No office rate
49595Abdominal hernia repairFor an initial, reducible anterior abdominal hernia larger than 10 cm.No office rate

49540 billing questions

How is 49540 distinguished from an anterior abdominal hernia repair?

Use 49540 when the documented defect is lumbar, in the posterolateral abdominal wall. An anterior abdominal wall hernia is coded from the applicable anterior hernia family instead.

Does the 90-day global include postoperative visits?

Related postoperative care during the 90 days after surgery is included, as is the day-before preoperative visit.

How is bilateral lumbar hernia repair reported?

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

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.

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

CMS pays the highest-valued procedure in full and the other procedures at 50%. The 90-day global also covers related postoperative care for this repair.

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 49540PPRRVU2026_Oct_nonQPP.csv, line 5,832 (RVU26D)

Open CMS sourceHow we calculate rates

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