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Billing code 49615: Hernia repairMedicare rate & RVUs

Reports repair of a recurrent, reducible anterior abdominal hernia measuring 3–10 cm, using an open, laparoscopic, or robotic approach.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.9K Medicare services in 2024

Medicare pays $583.85 for 49615 nationally in a facility.

Medicare rate · 49615

Hernia repair

Swap in your local Medicare rate.

Work RVUs
11.17
Total RVUs
17.48
Global days
000

National rate · 2026

$583.85

Facility setting, before claim adjustments.

See every locality for 49615 → · 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 49615 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 49615 covers

A surgeon repairs a hernia that has returned after a prior repair at the same site. The code applies to an anterior abdominal hernia, such as an incisional, ventral, umbilical, epigastric, or Spigelian hernia, when the defect is recurrent, reducible, and 3–10 cm. The repair may be performed through an open incision or by a laparoscopic or robotic approach. These operations are commonly performed in a hospital or ambulatory surgery center.

Select the code using the operative findings: document the prior repair, the defect’s measured size, and that the hernia was reducible. Mesh or another prosthesis used as part of the repair is included in the hernia-repair service. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed 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. Assistant-at-surgery services 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 49615 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

49615 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$527.47
Alaska*Unavailable$734.13
ArizonaUnavailable$566.33
ArkansasUnavailable$520.69
AtlantaUnavailable$606.32
AustinUnavailable$580.10
BakersfieldUnavailable$563.83
Baltimore/Surr. CntysUnavailable$621.14
BeaumontUnavailable$566.73
BrazoriaUnavailable$564.43

49615 rates by state

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

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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
49615 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 49615 rate is calculated

Each of 49615’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 · 49615

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 11.17Practice expense 3.40Malpractice 2.91

17.4800 adjusted RVUs×$33.4009 conversion factor=$583.85

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

Payment rules and modifiers for 49615

The CMS indicators that decide how 49615 is paid alongside other services.

CMS payment indicators · 49615

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

49615 without 51 · national facility

$583.85

Hernia repair

49615-51 · Second procedure: 50%

$291.93

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

49615 compared with similar codes

Compare codes

49615 vs 49613 vs 49616 vs 49617: national Medicare rates

Swap in your local Medicare rate.

  • 49615
    Hernia repair · 11.17 wRVU
    —
  • 49613
    Abdominal hernia repair · 7.23 wRVU
    —
  • 49616
    Hernia repair · 15.16 wRVU
    —
  • 49617
    Abdominal hernia repair · 15.63 wRVU
    —

How to choose

49613Abdominal hernia repair
Choose 49613 for an initial, reducible repair of a 3–10 cm anterior abdominal hernia. Code 49615 applies when the hernia has recurred after a prior repair.
49616Hernia repair
Both codes describe recurrent hernias in the 3–10 cm range; 49616 is for an incarcerated or strangulated hernia, while 49615 is for a reducible hernia.
49617Abdominal hernia repair
Both describe recurrent, reducible hernias. Use 49615 for a 3–10 cm defect and 49617 for a defect larger than 10 cm.

Codes related to 49615

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

Codes related to 49615
CodeHow it relatesNational office range
Same family
49613Abdominal hernia repairInitial, reducible repair in the same 3–10 cm size range.No office rate
49614Hernia repairInitial repair in the same size range when incarcerated or strangulated.No office rate
49616Hernia repairRecurrent repair in the same size range when incarcerated or strangulated.No office rate
49617Abdominal hernia repairRecurrent, reducible repair for a defect larger than 10 cm.No office rate
49618Abdominal hernia repairRecurrent repair for a defect larger than 10 cm when incarcerated or strangulated.No office rate

49615 billing questions

How is this code distinguished from 49613?

Both describe a reducible anterior abdominal hernia measuring 3–10 cm. Use 49615 for a recurrent hernia and 49613 for an initial repair.

What documentation supports reporting 49615?

The operative report should establish that the hernia is recurrent, document the defect measurement, and describe its reducibility. It should also identify the repair performed.

Can mesh placement be reported separately?

Mesh or another prosthesis used in the hernia repair is included in the repair service; do not report it separately as an additional mesh-implantation service.

Does the code vary by open, laparoscopic, or robotic approach?

No. The code covers the qualifying repair regardless of whether the surgeon uses an open, laparoscopic, or robotic approach.

Can modifier 50 be used for a bilateral repair?

No. CMS identifies bilateral adjustment as inappropriate for this code.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The code has a 0-day global period, including same-day preoperative and postoperative care.

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 49615PPRRVU2026_Oct_nonQPP.csv, line 5,850 (RVU26D)

Open CMS sourceHow we calculate rates

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