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Billing code 49610: Gastroschisis repairMedicare rate & RVUs

Reports operative repair of gastroschisis in a newborn when the abdominal contents are reduced and the abdominal wall is closed in a primary repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $662.67 for 49610 nationally in a facility.

Medicare rate · 49610

Gastroschisis repair

Work RVUs
10.64
Total RVUs
19.84
Global days
090

National rate · 2026

$662.67

Facility setting, before claim adjustments.

See every locality for 49610 →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 49610 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 49610 covers

This code describes operative treatment of gastroschisis in a newborn: the surgeon returns the exposed abdominal contents to the abdomen and closes the abdominal wall defect. Pediatric surgeons typically perform the repair in a hospital operating room shortly after birth. A primary closure is used when the defect can be closed at the initial repair; staged management uses a different code.

Report the code when the operative record supports primary repair of gastroschisis, including the newborn’s diagnosis and the closure performed. The 90-day global period includes the day-before preoperative visit and related postoperative care during the following 90 days. 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% reduction. Modifier 50 is inappropriate for this midline defect. Assistant-at-surgery payment may be available; 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 49610 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

49610 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$594.95
Alaska*Unavailable$811.58
ArizonaUnavailable$642.43
ArkansasUnavailable$586.71
AtlantaUnavailable$686.21
AustinUnavailable$664.89
BakersfieldUnavailable$652.73
Baltimore/Surr. CntysUnavailable$706.35
BeaumontUnavailable$636.82
BrazoriaUnavailable$642.74

49610 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
49610 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 49610 rate is calculated

Each of 49610’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 · 49610

RVUs × geographic indexes × conversion factor

Work10.64

10.64 RVUs× 1.000 GPCI

Practice expense6.36

6.36 RVUs× 1.000 GPCI

Malpractice2.84

2.84 RVUs× 1.000 GPCI

Adjusted RVUs

19.8400

Conversion factor

$33.4009

Medicare rate

$662.67

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

Payment rules and modifiers for 49610

49610 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 49610

Gastroschisis 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)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.
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 · 49610

Gastroschisis 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 51 · payment effect

With and without the modifier

49610 without 51 · national facility

$662.67

Gastroschisis repair

49610-51 · Second procedure: 50%

$331.34

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

49610 compared with similar codes

Compare codes · National

49610 vs 49611 vs 49600: Medicare rates

  • 49610

    Gastroschisis repair10.64 wRVU

    Not priced

  • 49611

    Umbilical hernia repair9.11 wRVU

    Not priced

  • 49600

    Umbilical repair11.26 wRVU

    Not priced

How to choose

49611Umbilical hernia repair
49610 describes primary gastroschisis repair. Choose 49611 when the operative plan uses staged closure.
49600Umbilical repair
49600 is in the omphalocele repair group. Gastroschisis is a separate congenital defect and is reported with its own repair code.

Codes related to 49610

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

Codes related to 49610
CodeHow it relatesNational office range
Used instead
49611Umbilical hernia repairUsed instead for staged closure of newborn gastroschisis.No office rate
49600Umbilical repairIn the omphalocele repair group, for a different congenital abdominal wall defect.No office rate
49605Umbilical hernia repairAnother omphalocele repair code; gastroschisis is a different defect.No office rate
49606Omphalocele repairAlso for omphalocele repair, rather than gastroschisis.No office rate

49610 billing questions

How does this differ from 49611?

Use 49610 for primary repair of gastroschisis. Use 49611 when the operative treatment is a staged closure.

Is this the code for omphalocele repair?

No. Gastroschisis and omphalocele are distinct congenital abdominal wall defects; codes 49600, 49605, and 49606 are in the omphalocele repair group.

What documentation supports reporting 49610?

Document the newborn’s gastroschisis and the operative reduction and primary abdominal wall closure. The record should make clear that the procedure was not a staged closure.

Can modifier 50 be used?

No. The defect is midline, so modifier 50 is inappropriate.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, with other procedures subject to the standard multiple-procedure reduction.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; 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 49610PPRRVU2026_Oct_nonQPP.csv, line 5,846 (RVU26D)

Open CMS sourceHow we calculate rates

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