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Billing code 49596: Abdominal hernia repairMedicare rate & RVUs

Reports initial repair of an anterior abdominal hernia with a defect over 10 cm that is incarcerated or strangulated, using any surgical approach.

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

Medicare pays $936.56 for 49596 nationally in a facility.

Medicare rate · 49596

Abdominal hernia repair

Swap in your local Medicare rate.

Work RVUs
18.2
Total RVUs
28.04
Global days
000

National rate · 2026

$936.56

Facility setting, before claim adjustments.

See every locality for 49596 → · 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 49596 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 49596 covers

This code covers initial repair of an anterior abdominal hernia, such as a ventral, incisional, umbilical, or epigastric hernia, when the hernia is incarcerated or strangulated and the defect exceeds 10 cm. General surgeons commonly perform the repair in a hospital or ambulatory surgical setting. The code includes open, laparoscopic, and robotic approaches, and includes mesh or another prosthesis when used.

Select the code from the operative findings: document that the repair is initial, the hernia’s incarcerated or strangulated status, and the defect measurement. When multiple defects are repaired, document their measurements to support the applicable size category. Same-day preoperative and postoperative care is included in the 0-day global period. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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 49596 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

49596 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$846.66
Alaska*Unavailable$1,180.67
ArizonaUnavailable$908.52
ArkansasUnavailable$835.87
AtlantaUnavailable$972.87
AustinUnavailable$929.67
BakersfieldUnavailable$902.72
Baltimore/Surr. CntysUnavailable$996.19
BeaumontUnavailable$909.98
BrazoriaUnavailable$905.13

49596 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
49596 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 49596 rate is calculated

Each of 49596’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 · 49596

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 18.20Practice expense 5.11Malpractice 4.73

28.0400 adjusted RVUs×$33.4009 conversion factor=$936.56

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

Payment rules and modifiers for 49596

The CMS indicators that decide how 49596 is paid alongside other services.

CMS payment indicators · 49596

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

49596 without 51 · national facility

$936.56

Abdominal hernia repair

49596-51 · Second procedure: 50%

$468.28

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

49596 compared with similar codes

Compare codes

49596 vs 49595 vs 49594 vs 49618: national Medicare rates

Swap in your local Medicare rate.

  • 49596
    Abdominal hernia repair · 18.2 wRVU
    —
  • 49595
    Abdominal hernia repair · 13.59 wRVU
    —
  • 49594
    Hernia repair · 13.12 wRVU
    —
  • 49618
    Abdominal hernia repair · 22.1 wRVU
    —

How to choose

49595Abdominal hernia repair
Use 49595 when the initial anterior abdominal hernia is reducible. Code 49596 when it is incarcerated or strangulated; both are for defects over 10 cm.
49594Hernia repair
This code is for an initial incarcerated or strangulated repair with a 3-to-10-cm defect. Code 49596 applies when the defect is over 10 cm.
49618Abdominal hernia repair
Use 49618 for a recurrent incarcerated or strangulated anterior abdominal hernia with a defect over 10 cm. Code 49596 describes an initial repair.

Codes related to 49596

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

Codes related to 49596
CodeHow it relatesNational office range
Same family
49595Abdominal hernia repairInitial repair of an over-10-cm anterior abdominal hernia when reducible.No office rate
49594Hernia repairInitial incarcerated or strangulated repair when the defect is 3 to 10 cm.No office rate
49591Hernia repairInitial reducible repair when the defect is under 3 cm.No office rate
49593Abdominal hernia repairInitial reducible repair when the defect is 3 to 10 cm.No office rate
Used instead
49618Abdominal hernia repairFor recurrent rather than initial incarcerated or strangulated repair over 10 cm.No office rate

49596 billing questions

How is this code distinguished from 49595?

Both describe initial repair of an anterior abdominal hernia with a defect over 10 cm. Use 49596 for an incarcerated or strangulated hernia and 49595 when it is reducible.

Does the repair approach change code selection?

No. This code covers open, laparoscopic, and robotic repair; select it based on initial versus recurrent status, defect size, and reducibility or strangulation.

Can mesh be billed separately with this repair?

Mesh or another prosthesis used for the hernia repair is included in the code.

What documentation supports the over-10-cm category?

The operative report should record the defect measurement and the incarcerated or strangulated status. Document measurements for multiple repaired defects to support the selected size category.

Should modifier 50 be used for bilateral hernias?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

How are other same-session procedures paid?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures in the same session are paid at 50%.

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 49596PPRRVU2026_Oct_nonQPP.csv, line 5,842 (RVU26D)

Open CMS sourceHow we calculate rates

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