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Billing code 49650: Inguinal hernia repairMedicare rate & RVUs

Reports laparoscopic repair of an initial inguinal hernia, typically performed by a surgeon to reduce the hernia and reinforce the repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities81.5K Medicare services in 2024

Medicare pays $424.19 for 49650 nationally in a facility.

Medicare rate · 49650

Inguinal hernia repair

Swap in your local Medicare rate.

Work RVUs
6.2
Total RVUs
12.70
Global days
090

National rate · 2026

$424.19

Facility setting, before claim adjustments.

See every locality for 49650 → · 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 49650 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 49650 covers

A surgeon repairs an initial inguinal hernia through small abdominal incisions using a laparoscope and surgical instruments. The surgeon reduces the hernia and repairs the defect, commonly reinforcing the area with mesh. This approach is performed in hospital operating rooms and ambulatory surgery centers; transabdominal preperitoneal and totally extraperitoneal approaches are common. Mesh placement is part of the repair rather than a separate service under this code.

Report this code for laparoscopic repair of an initial, not recurrent, inguinal hernia. The operative report should support the laparoscopic approach, hernia site, and whether the repair is initial or recurrent. For bilateral repair in the same session, CMS pays 150% when modifier 50 is reported. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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 49650 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

49650 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$380.23
Alaska*Unavailable$513.86
ArizonaUnavailable$411.31
ArkansasUnavailable$374.85
AtlantaUnavailable$438.36
AustinUnavailable$427.83
BakersfieldUnavailable$422.45
Baltimore/Surr. CntysUnavailable$452.28
BeaumontUnavailable$405.69
BrazoriaUnavailable$412.41

49650 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
49650 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 49650 rate is calculated

Each of 49650’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 · 49650

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 6.20Practice expense 4.87Malpractice 1.63

12.7000 adjusted RVUs×$33.4009 conversion factor=$424.19

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

Payment rules and modifiers for 49650

49650 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 49650

Inguinal hernia 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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
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 · 49650

Inguinal hernia 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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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 50 · payment effect

With and without the modifier

49650 without 50 · national facility

$424.19

Inguinal hernia repair

49650-50 · Bilateral: 150%

$636.29

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

49650 compared with similar codes

Compare codes

49650 vs 49651 vs 49505 vs 49507: national Medicare rates

Swap in your local Medicare rate.

  • 49650
    Inguinal hernia repair · 6.2 wRVU
    —
  • 49651
    Inguinal hernia repair · 8.17 wRVU
    —
  • 49505
    Inguinal hernia repair · 7.76 wRVU
    —
  • 49507
    Inguinal hernia repair · 8.86 wRVU
    —

How to choose

49651Inguinal hernia repair
Both describe laparoscopic inguinal hernia repair; use 49651 for recurrent hernias and 49650 for initial repairs.
49505Inguinal hernia repair
This is an open repair of an initial inguinal hernia. Use 49650 when the repair is performed laparoscopically.
49507Inguinal hernia repair
This is an open repair of an incarcerated or strangulated initial inguinal hernia; 49650 identifies laparoscopic initial repair.

Codes related to 49650

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

Codes related to 49650
CodeHow it relatesNational office range
Same family
49651Inguinal hernia repairLaparoscopic inguinal hernia repair for a recurrent rather than initial hernia.No office rate
Used instead
49505Inguinal hernia repairOpen repair of an initial inguinal hernia rather than laparoscopic repair.No office rate
49507Inguinal hernia repairOpen repair when an initial inguinal hernia is incarcerated or strangulated.No office rate

49650 billing questions

When should 49651 be reported instead?

Report 49651 for laparoscopic repair of a recurrent inguinal hernia. Code 49650 is for an initial repair.

Is mesh separately reported with 49650?

Mesh used to reinforce the laparoscopic inguinal repair is included in the repair service; do not report it as a separate mesh service.

How is bilateral repair reported?

For repair of both sides in the same session, report modifier 50. CMS pays the bilateral procedure at 150%.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; CMS does not permit team surgery for this code.

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 49650PPRRVU2026_Oct_nonQPP.csv, line 5,857 (RVU26D)

Open CMS sourceHow we calculate rates

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