FeeBase
Log inGet started
Menu

Billing code 49621: Hernia repairMedicare rate & RVUs

Repair a reducible hernia surrounding a stoma, using an open or minimally invasive approach, with mesh implantation included when performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.8K Medicare services in 2024

Medicare pays $683.38 for 49621 nationally in a facility.

Medicare rate · 49621

Hernia repair

Swap in your local Medicare rate.

Work RVUs
13.36
Total RVUs
20.46
Global days
000

National rate · 2026

$683.38

Facility setting, before claim adjustments.

See every locality for 49621 → · 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 49621 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 49621 covers

This service repairs a hernia at the abdominal opening where a colostomy, ileostomy, or other stoma passes through the abdominal wall. The surgeon returns the hernia contents and repairs the defect; the hernia is reducible when its contents can be returned. The code covers open, laparoscopic, and robotic approaches, and includes mesh or another prosthesis when implanted. It is generally performed by a general or colorectal surgeon in an operating room.

Report this code for a reducible parastomal hernia, not a hernia at another abdominal site or an incarcerated or strangulated parastomal hernia. The operative note should identify the stoma site, describe the hernia and its reducibility, and document the repair approach and any prosthesis. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in one 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 payment may be made; 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 49621 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

49621 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$621.13
Alaska*Unavailable$867.66
ArizonaUnavailable$664.10
ArkansasUnavailable$613.64
AtlantaUnavailable$708.04
AustinUnavailable$679.88
BakersfieldUnavailable$663.23
Baltimore/Surr. CntysUnavailable$725.14
BeaumontUnavailable$664.04
BrazoriaUnavailable$662.55

49621 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
49621 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 49621 rate is calculated

Each of 49621’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 · 49621

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.36Practice expense 3.94Malpractice 3.16

20.4600 adjusted RVUs×$33.4009 conversion factor=$683.38

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

Payment rules and modifiers for 49621

The CMS indicators that decide how 49621 is paid alongside other services.

CMS payment indicators · 49621

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

49621 without 51 · national facility

$683.38

Hernia repair

49621-51 · Second procedure: 50%

$341.69

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

49621 compared with similar codes

Compare codes

49621 vs 49622 vs 49613 vs 49615: national Medicare rates

Swap in your local Medicare rate.

  • 49621
    Hernia repair · 13.36 wRVU
    —
  • 49622
    Parastomal hernia repair · 16.63 wRVU
    —
  • 49613
    Abdominal hernia repair · 7.23 wRVU
    —
  • 49615
    Hernia repair · 11.17 wRVU
    —

How to choose

49622Parastomal hernia repair
Choose 49621 for a reducible parastomal hernia. Choose 49622 when the parastomal hernia is incarcerated or strangulated.
49613Abdominal hernia repair
49613 is for a qualifying anterior abdominal hernia under 3 cm, not a hernia around a stoma.
49615Hernia repair
49615 is for a qualifying anterior abdominal hernia 3–10 cm. A hernia at the stoma site is classified with the parastomal hernia codes instead.

Codes related to 49621

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

Codes related to 49621
CodeHow it relatesNational office range
Same family
49622Parastomal hernia repairParastomal hernia repair for an incarcerated or strangulated hernia.No office rate
Used instead
49613Abdominal hernia repairAnterior abdominal hernia repair for a qualifying non-parastomal defect under 3 cm.No office rate
49615Hernia repairAnterior abdominal hernia repair for a qualifying non-parastomal defect 3–10 cm.No office rate

49621 billing questions

How does this code differ from 49622?

49621 is for a reducible parastomal hernia. Use 49622 when the parastomal hernia is incarcerated or strangulated.

Does the code include mesh placement?

Yes. Mesh or another prosthesis is included when implanted as part of the parastomal hernia repair.

Can modifier 50 be used for a parastomal hernia?

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

What should the operative note document?

Document the stoma site, the parastomal hernia and its reducibility, the repair performed, and any implanted prosthesis.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full; other procedures performed in the same session are subject to the standard 50% multiple-procedure reduction.

Is assistant-at-surgery payment available?

CMS indicates that assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation.

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 49621PPRRVU2026_Oct_nonQPP.csv, line 5,854 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 49621 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 49621 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →