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Billing code 49613: Abdominal hernia repairMedicare rate & RVUs

Reports repair of a recurrent, reducible anterior abdominal hernia when the total length of the repaired defect or defects is under 3 cm.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.3K Medicare services in 2024

Medicare pays $387.12 for 49613 nationally in a facility.

Medicare rate · 49613

Abdominal hernia repair

Work RVUs
7.23
Total RVUs
11.59
Global days
000

National rate · 2026

$387.12

Facility setting, before claim adjustments.

See every locality for 49613 →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 49613 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 49613 covers

This code describes repair of a previously repaired anterior abdominal hernia that is reducible and has a total defect length under 3 cm. These repairs are commonly performed by general surgeons in a hospital or ambulatory surgery setting. The code covers recognized anterior abdominal hernia sites, such as incisional, ventral, umbilical, epigastric, and Spigelian hernias, and includes mesh or other prosthesis implantation when performed. The repair may use an open, laparoscopic, or robotic approach.

Select the code using the hernia’s recurrence status, reducibility, and total length of the defect or defects repaired. The operative report should establish the prior repair, reducibility, measured defect length, and repair performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. 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 49613 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

49613 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$349.72
Alaska*Unavailable$485.39
ArizonaUnavailable$375.58
ArkansasUnavailable$345.21
AtlantaUnavailable$401.66
AustinUnavailable$385.36
BakersfieldUnavailable$375.43
Baltimore/Surr. CntysUnavailable$411.80
BeaumontUnavailable$375.19
BrazoriaUnavailable$374.63

49613 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

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
49613 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 49613 rate is calculated

Each of 49613’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 · 49613

RVUs × geographic indexes × conversion factor

Work7.23

7.23 RVUs× 1.000 GPCI

Practice expense2.50

2.50 RVUs× 1.000 GPCI

Malpractice1.86

1.86 RVUs× 1.000 GPCI

Adjusted RVUs

11.5900

Conversion factor

$33.4009

Medicare rate

$387.12

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

Payment rules and modifiers for 49613

The CMS indicators that decide how 49613 is paid alongside other services.

CMS payment indicators · 49613

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

49613 without 51 · national facility

$387.12

Abdominal hernia repair

49613-51 · Second procedure: 50%

$193.56

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

49613 compared with similar codes

Compare codes · National

4 codes, side by side

  • 49613

    Abdominal hernia repair7.23 wRVU

    Not priced

  • 49614

    Hernia repair9.99 wRVU

    Not priced

  • 49615

    Hernia repair11.17 wRVU

    Not priced

  • 49591

    Hernia repair5.81 wRVU

    Not priced

How to choose

49614Hernia repair
Both are for recurrent defects under 3 cm. Choose 49613 for a reducible hernia and 49614 for an incarcerated or strangulated hernia.
49615Hernia repair
This code is for recurrent, reducible defects under 3 cm; 49615 is for the same recurrence and reducibility status when total defect length is 3–10 cm.
49591Hernia repair
Both describe reducible anterior abdominal hernia repair under 3 cm. 49613 is for a recurrent hernia; 49591 is for an initial repair.

Codes related to 49613

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

Codes related to 49613
CodeHow it relatesNational office range
Same family
49614Hernia repairRecurrent defect under 3 cm when incarcerated or strangulated.No office rate
49615Hernia repairRecurrent, reducible repair when total defect length is 3–10 cm.No office rate
49616Hernia repairRecurrent, incarcerated or strangulated repair when total defect length is 3–10 cm.No office rate
49617Abdominal hernia repairRecurrent, reducible repair when total defect length exceeds 10 cm.No office rate
49591Hernia repairInitial, reducible repair for a defect under 3 cm.No office rate

49613 billing questions

How is this code distinguished from 49614?

Both describe recurrent anterior abdominal hernia repair for a defect under 3 cm. Use 49613 when the hernia is reducible; 49614 is for an incarcerated or strangulated hernia.

Does the code include mesh placement?

Yes. Mesh or another prosthesis is included in the hernia repair code when implanted during the repair.

What documentation supports the under-3-cm level?

Document the total length of the defect or defects repaired, along with the operative findings that establish recurrence and reducibility.

Should modifier 50 be used for a bilateral repair?

No. Modifier 50 is inappropriate for this code; CMS does not apply a bilateral adjustment to it.

How are other procedures in the same session paid?

CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to the other procedures.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. 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 49613PPRRVU2026_Oct_nonQPP.csv, line 5,848 (RVU26D)

Open CMS sourceHow we calculate rates

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