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Billing code 49595: Abdominal hernia repairMedicare rate & RVUs

Repair of an initial, reducible anterior abdominal wall hernia with total defect length over 10 cm, regardless of open, laparoscopic, or robotic approach.

CMS RVU26DEffective Oct 1, 2026109 payment localities5.3K Medicare services in 2024

Medicare pays $704.42 for 49595 nationally in a facility.

Medicare rate · 49595

Abdominal hernia repair

Swap in your local Medicare rate.

Work RVUs
13.59
Total RVUs
21.09
Global days
000

National rate · 2026

$704.42

Facility setting, before claim adjustments.

See every locality for 49595 → · 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 49595 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 49595 covers

49595 represents operative repair of an initial anterior abdominal wall hernia when the total length of the defect or defects exceeds 10 cm and the hernia is reducible. The category includes ventral, incisional, umbilical, epigastric, and Spigelian hernias. The code covers open, laparoscopic, and robotic repair, so the approach does not determine code selection. Surgeons commonly perform this repair in hospital or ambulatory surgery settings; mesh or other prosthetic reinforcement, when used as part of the repair, is included in the service.

Select the code using the total defect length, reducibility, and whether the repair is initial rather than recurrent. The operative report should support those details, including the measured defect length. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures subject to the standard reduction are performed 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 49595 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

49595 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$637.30
Alaska*Unavailable$888.09
ArizonaUnavailable$683.56
ArkansasUnavailable$629.23
AtlantaUnavailable$731.24
AustinUnavailable$699.93
BakersfieldUnavailable$680.65
Baltimore/Surr. CntysUnavailable$748.98
BeaumontUnavailable$684.08
BrazoriaUnavailable$681.35

49595 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
49595 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 49595 rate is calculated

Each of 49595’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 · 49595

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.59Practice expense 4.03Malpractice 3.47

21.0900 adjusted RVUs×$33.4009 conversion factor=$704.42

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

Payment rules and modifiers for 49595

The CMS indicators that decide how 49595 is paid alongside other services.

CMS payment indicators · 49595

Abdominal 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

49595 without 51 · national facility

$704.42

Abdominal hernia repair

49595-51 · Second procedure: 50%

$352.21

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

49595 compared with similar codes

Compare codes

49595 vs 49593 vs 49594 vs 49596 vs 49617: national Medicare rates

Swap in your local Medicare rate.

  • 49595
    Abdominal hernia repair · 13.59 wRVU
    —
  • 49593
    Abdominal hernia repair · 10 wRVU
    —
  • 49594
    Hernia repair · 13.12 wRVU
    —
  • 49596
    Abdominal hernia repair · 18.2 wRVU
    —
  • 49617
    Abdominal hernia repair · 15.63 wRVU
    —

How to choose

49593Abdominal hernia repair
Both describe initial, reducible anterior abdominal hernia repair. Choose 49593 for total defect length from 3 cm through 10 cm; 49595 is for a length over 10 cm.
49594Hernia repair
49594 covers a nonreducible or strangulated initial hernia measuring 3 cm through 10 cm. 49595 is reducible and over 10 cm.
49596Abdominal hernia repair
Both apply to an initial repair over 10 cm. Use 49595 when the hernia is reducible and 49596 when it is nonreducible or strangulated.
49617Abdominal hernia repair
49617 is for a recurrent reducible anterior abdominal hernia over 10 cm; 49595 is for an initial repair with the same size and reducibility.

Codes related to 49595

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

Codes related to 49595
CodeHow it relatesNational office range
Same family
49591Hernia repairInitial reducible repair in the same family for defects under 3 cm.No office rate
49593Abdominal hernia repairInitial reducible repair for defects 3 cm through 10 cm.No office rate
49594Hernia repairInitial nonreducible or strangulated repair for defects 3 cm through 10 cm.No office rate
49596Abdominal hernia repairInitial repair over 10 cm when the hernia is nonreducible or strangulated.No office rate
Used instead
49617Abdominal hernia repairFor a recurrent reducible anterior abdominal hernia over 10 cm.No office rate

49595 billing questions

How is 49595 distinguished from 49593?

49595 is for a total defect length over 10 cm. 49593 applies when the total length is 3 cm through 10 cm and the hernia is reducible.

When should 49596 be used instead?

Use 49596 for an initial anterior abdominal hernia over 10 cm that is nonreducible or strangulated. 49595 is for a reducible hernia in that size category.

Does the surgical approach change code selection?

No. The code covers open, laparoscopic, and robotic repair; select it based on initial versus recurrent status, reducibility, and total defect length.

Can mesh placement be billed separately?

Mesh or other prosthetic reinforcement used as part of the hernia repair is included in the service represented by 49595.

What should the operative note document?

Document that the repair is initial, that the hernia is reducible, and the total measured length of the defect or defects.

How are assistant and co-surgeon services handled?

An assistant at surgery may be paid. 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 49595PPRRVU2026_Oct_nonQPP.csv, line 5,841 (RVU26D)

Open CMS sourceHow we calculate rates

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