Billing code 49605: Umbilical hernia repairMedicare rate & RVUs

Medicare pays $4,491.09 for 49605 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 49605 covers

This code represents an operation to repair a hernia at the umbilicus. A surgeon typically exposes the defect, returns or manages the hernia contents as indicated, and repairs the abdominal wall. The service is performed in an operative setting; the operative report should identify the umbilical site and describe the repair actually carried out.

Select this code only when the documented operation meets its full billing code descriptor; the brief CMS label alone does not establish distinctions among neighboring umbilical-repair codes. The report should support the diagnosis, site, operative work, and any descriptor-specific selection factors. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same 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 for this code. Assistant-at-surgery payment may be allowed; 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 49605 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

49605 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 49605 rate is calculated

Each of 49605’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.

Payment rules and modifiers for 49605

49605 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

49605 compared with similar codes

How to choose

49600Umbilical repair

Both are in the umbilical-repair group. Compare the complete code-year descriptors and documented operative circumstances rather than relying on the abbreviated CMS labels.

49606Omphalocele repair

This is a neighboring umbilical-repair code, not an interchangeable label. The applicable descriptor and operative documentation determine which code fits.

49591Hernia repair

This code belongs to the anterior abdominal hernia repair family. Use it only when its descriptor-specific criteria fit; do not select it solely because the hernia is near the umbilicus.

49613Abdominal hernia repair

This code describes recurrent anterior abdominal hernia repair when its criteria are met. Distinguish it from 49605 using the documented history and the applicable descriptors.

Codes related to 49605

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

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

Open CMS sourceHow we calculate rates