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Billing code 49594: Hernia repairMedicare rate & RVUs

Repair an initial anterior abdominal wall hernia with a 3–10 cm defect that is incarcerated or strangulated, including mesh placement when performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities20K Medicare services in 2024

Medicare pays $682.38 for 49594 nationally in a facility.

Medicare rate · 49594

Hernia repair

Swap in your local Medicare rate.

Work RVUs
13.12
Total RVUs
20.43
Global days
000

National rate · 2026

$682.38

Facility setting, before claim adjustments.

See every locality for 49594 → · 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 49594 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 49594 covers

This code represents repair of an initial anterior abdominal wall hernia, such as a ventral, incisional, umbilical, or epigastric hernia, when the defect measures 3–10 cm and the hernia is incarcerated or strangulated. A surgeon performs the repair, commonly in a hospital or ambulatory surgery center. Mesh implantation, when performed as part of the repair, is included in the service.

Choose the code based on the documented defect length, whether the hernia is reducible or incarcerated/strangulated, and whether the repair is initial rather than recurrent. The operative report should support the site, defect measurement, and nonreducible or strangulated status. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeons require 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 49594 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

49594 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$616.25
Alaska*Unavailable$858.13
ArizonaUnavailable$661.79
ArkansasUnavailable$608.31
AtlantaUnavailable$708.92
AustinUnavailable$677.60
BakersfieldUnavailable$658.03
Baltimore/Surr. CntysUnavailable$726.11
BeaumontUnavailable$662.60
BrazoriaUnavailable$659.37

49594 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
49594 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 49594 rate is calculated

Each of 49594’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 · 49594

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.12Practice expense 3.86Malpractice 3.45

20.4300 adjusted RVUs×$33.4009 conversion factor=$682.38

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

Payment rules and modifiers for 49594

The CMS indicators that decide how 49594 is paid alongside other services.

CMS payment indicators · 49594

Hernia repair

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

49594 without 51 · national facility

$682.38

Hernia repair

49594-51 · Second procedure: 50%

$341.19

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

49594 compared with similar codes

Compare codes

49594 vs 49593 vs 49592 vs 49596 vs 49614: national Medicare rates

Swap in your local Medicare rate.

  • 49594
    Hernia repair · 13.12 wRVU
    —
  • 49593
    Abdominal hernia repair · 10 wRVU
    —
  • 49592
    Abdominal hernia repair · 8.25 wRVU
    —
  • 49596
    Abdominal hernia repair · 18.2 wRVU
    —
  • 49614
    Hernia repair · 9.99 wRVU
    —

How to choose

49593Abdominal hernia repair
Both cover initial repair of a 3–10 cm defect. Choose 49594 for an incarcerated or strangulated hernia and 49593 when it is reducible.
49592Abdominal hernia repair
This code covers an initial incarcerated or strangulated hernia with a defect smaller than 3 cm; 49594 is for a 3–10 cm defect.
49596Abdominal hernia repair
Both cover initial incarcerated or strangulated hernias, but 49596 is for a defect larger than 10 cm.
49614Hernia repair
Use 49614 for a recurrent incarcerated or strangulated anterior abdominal hernia with a 3–10 cm defect; 49594 describes an initial repair.

Codes related to 49594

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

Codes related to 49594
CodeHow it relatesNational office range
Same family
49593Abdominal hernia repairInitial repair for a 3–10 cm anterior abdominal hernia when reducible.No office rate
49592Abdominal hernia repairInitial repair for an incarcerated or strangulated defect smaller than 3 cm.No office rate
49596Abdominal hernia repairInitial repair for an incarcerated or strangulated defect larger than 10 cm.No office rate
49595Abdominal hernia repairInitial repair for a reducible defect larger than 10 cm.No office rate
Used instead
49614Hernia repairFor a recurrent, rather than initial, incarcerated or strangulated anterior abdominal hernia with a 3–10 cm defect.No office rate

49594 billing questions

How does 49594 differ from 49593?

Both describe an initial anterior abdominal hernia repair for a 3–10 cm defect. Use 49594 for an incarcerated or strangulated hernia; 49593 is for a reducible hernia.

Is mesh separately reported with 49594?

Mesh implantation performed as part of the hernia repair is included in this service.

What documentation supports 49594?

The operative report should identify the hernia and its reducibility or strangulated status, document the defect measurement, and establish that the repair is initial rather than recurrent.

Does 49594 have a postoperative global period?

It has a 0-day global period. Same-day preoperative and postoperative care is included.

Can modifier 50 be used for bilateral repair?

No. CMS identifies bilateral adjustment as inappropriate for this code.

How does Medicare handle other procedures performed in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and 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 49594PPRRVU2026_Oct_nonQPP.csv, line 5,840 (RVU26D)

Open CMS sourceHow we calculate rates

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