No office rate
Both describe open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma. Select 49190 for a lesion over 30 cm and 49189 for one measuring 20.1 to 30 cm.
On this page
CMS RVU26D · Effective 2026-10-01
49190 in Modesto
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$2558.68
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
General surgery
About 49190: Open removal or destruction of a very large intra-abdominal lesion
Reports open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma when its documented size exceeds 30 cm.
This code covers an open operation to remove or destroy an intra-abdominal tumor, cyst, or endometrioma measuring more than 30 cm. A surgeon may perform the procedure through an open abdominal approach in a hospital operating room. The lesion may be benign or malignant; the code’s size tier and open approach distinguish the service, not the lesion’s pathology.
Select this tier using the documented size of the treated lesion; the operative report should support the lesion type, its measurement, and the open excision or destruction performed. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 49190
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU48.75 · 62%
- Practice expense (office) RVU19.26 · 24%
- Malpractice RVU11.04 · 14%
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.
49190 compared with similar codes
Office rates for Modesto, from the same CMS release.
No office rate
49188 is the open excision or destruction tier for lesions measuring 10.1 to 20 cm; 49190 is reserved for lesions over 30 cm.
$178.87
49180 describes biopsy sampling of an abdominal mass. Use 49190 when the surgeon performs open excision or destruction of the qualifying large lesion.
The same code, a different location
How does Modesto compare?
49190 across payment areas
Same release and payment basis · bars start at $0
Modesto · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Madera
California · 49190
Office
Unavailable
Facility
$2558.68
No comparable office rate is available.
Merced
California · 49190
Office
Unavailable
Facility
$2558.68
No comparable office rate is available.
Napa
California · 49190
Office
Unavailable
Facility
$2766.07
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 49190
Office
Unavailable
Facility
$2664.00
No comparable office rate is available.
Redding
California · 49190
Office
Unavailable
Facility
$2558.68
No comparable office rate is available.
Rest Of California
California · 49190
Office
Unavailable
Facility
$2558.68
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 49190
Office
Unavailable
Facility
$2677.20
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 49190
Office
Unavailable
Facility
$2632.72
No comparable office rate is available.
Salinas
California · 49190
Office
Unavailable
Facility
$2622.01
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 49190
Office
Unavailable
Facility
$2646.39
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 49190
Office
Unavailable
Facility
$2859.29
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 49190
Office
Unavailable
Facility
$2846.75
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 49190
Office
Unavailable
Facility
$2932.69
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 49190
Office
Unavailable
Facility
$2881.44
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 49190
Office
Unavailable
Facility
$2586.34
No comparable office rate is available.
Santa Cruz-Watsonville
California · 49190
Office
Unavailable
Facility
$2641.75
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 49190
Office
Unavailable
Facility
$2621.62
No comparable office rate is available.
Santa Rosa-Petaluma
California · 49190
Office
Unavailable
Facility
$2664.76
No comparable office rate is available.
Stockton
California · 49190
Office
Unavailable
Facility
$2558.68
No comparable office rate is available.
Vallejo
California · 49190
Office
Unavailable
Facility
$2748.00
No comparable office rate is available.
Visalia
California · 49190
Office
Unavailable
Facility
$2558.68
No comparable office rate is available.
Yuba City
California · 49190
Office
Unavailable
Facility
$2558.68
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 49190
Office
Unavailable
Facility
$2884.44
No comparable office rate is available.
Miami
Florida · 49190
Office
Unavailable
Facility
$3230.53
No comparable office rate is available.
Chicago
Illinois · 49190
Office
Unavailable
Facility
$3132.48
No comparable office rate is available.
Manhattan
New York · 49190
Office
Unavailable
Facility
$3064.85
No comparable office rate is available.
Alaska*
Alaska · 49190
Office
Unavailable
Facility
$3330.74
No comparable office rate is available.
Alabama
Alabama · 49190
Office
Unavailable
Facility
$2399.89
No comparable office rate is available.
Arkansas
Arkansas · 49190
Office
Unavailable
Facility
$2370.79
No comparable office rate is available.
Arizona
Arizona · 49190
Office
Unavailable
Facility
$2567.30
No comparable office rate is available.
Colorado
Colorado · 49190
Office
Unavailable
Facility
$2620.30
No comparable office rate is available.
Connecticut
Connecticut · 49190
Office
Unavailable
Facility
$2799.88
No comparable office rate is available.
Delaware
Delaware · 49190
Office
Unavailable
Facility
$2603.52
No comparable office rate is available.
Fort Lauderdale
Florida · 49190
Office
Unavailable
Facility
$2946.65
No comparable office rate is available.
Rest Of Florida
Florida · 49190
Office
Unavailable
Facility
$2797.52
No comparable office rate is available.
Atlanta
Georgia · 49190
Office
Unavailable
Facility
$2729.64
No comparable office rate is available.
Rest Of Georgia
Georgia · 49190
Office
Unavailable
Facility
$2641.66
No comparable office rate is available.
Hawaii, Guam
Hawaii · 49190
Office
Unavailable
Facility
$2573.23
No comparable office rate is available.
Iowa
Iowa · 49190
Office
Unavailable
Facility
$2363.31
No comparable office rate is available.
Idaho
Idaho · 49190
Office
Unavailable
Facility
$2394.55
No comparable office rate is available.
East St. Louis
Illinois · 49190
Office
Unavailable
Facility
$2962.79
No comparable office rate is available.
Rest Of Illinois
Illinois · 49190
Office
Unavailable
Facility
$2791.98
No comparable office rate is available.
Suburban Chicago
Illinois · 49190
Office
Unavailable
Facility
$2953.78
No comparable office rate is available.
Indiana
Indiana · 49190
Office
Unavailable
Facility
$2403.84
No comparable office rate is available.
Kansas
Kansas · 49190
Office
Unavailable
Facility
$2395.69
No comparable office rate is available.
Kentucky
Kentucky · 49190
Office
Unavailable
Facility
$2537.59
No comparable office rate is available.
New Orleans
Louisiana · 49190
Office
Unavailable
Facility
$2652.54
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 49190
Office
Unavailable
Facility
$2550.87
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 49190
Office
Unavailable
Facility
$2791.34
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 49190
Office
Unavailable
Facility
$2625.63
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 49190
Office
Unavailable
Facility
$2800.75
No comparable office rate is available.
Rest Of Maryland
Maryland · 49190
Office
Unavailable
Facility
$2634.11
No comparable office rate is available.
Rest Of Maine
Maine · 49190
Office
Unavailable
Facility
$2449.49
No comparable office rate is available.
Southern Maine
Maine · 49190
Office
Unavailable
Facility
$2498.48
No comparable office rate is available.
Detroit
Michigan · 49190
Office
Unavailable
Facility
$2870.79
No comparable office rate is available.
Rest Of Michigan
Michigan · 49190
Office
Unavailable
Facility
$2631.94
No comparable office rate is available.
Minnesota
Minnesota · 49190
Office
Unavailable
Facility
$2399.40
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 49190
Office
Unavailable
Facility
$2592.62
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 49190
Office
Unavailable
Facility
$2610.20
No comparable office rate is available.
Rest Of Missouri
Missouri · 49190
Office
Unavailable
Facility
$2541.98
No comparable office rate is available.
Mississippi
Mississippi · 49190
Office
Unavailable
Facility
$2454.68
No comparable office rate is available.
Montana**
Montana · 49190
Office
Unavailable
Facility
$2639.60
No comparable office rate is available.
North Carolina
North Carolina · 49190
Office
Unavailable
Facility
$2464.12
No comparable office rate is available.
North Dakota**
North Dakota · 49190
Office
Unavailable
Facility
$2421.31
No comparable office rate is available.
Nebraska
Nebraska · 49190
Office
Unavailable
Facility
$2361.45
No comparable office rate is available.
New Hampshire
New Hampshire · 49190
Office
Unavailable
Facility
$2620.62
No comparable office rate is available.
Northern Nj
New Jersey · 49190
Office
Unavailable
Facility
$2870.93
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 49190
Office
Unavailable
Facility
$2800.42
No comparable office rate is available.
New Mexico
New Mexico · 49190
Office
Unavailable
Facility
$2661.07
No comparable office rate is available.
Nevada**
Nevada · 49190
Office
Unavailable
Facility
$2579.40
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 49190
Office
Unavailable
Facility
$3182.15
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 49190
Office
Unavailable
Facility
$2852.16
No comparable office rate is available.
Queens
New York · 49190
Office
Unavailable
Facility
$3024.62
No comparable office rate is available.
Rest Of New York
New York · 49190
Office
Unavailable
Facility
$2498.66
No comparable office rate is available.
Ohio
Ohio · 49190
Office
Unavailable
Facility
$2587.32
No comparable office rate is available.
Oklahoma
Oklahoma · 49190
Office
Unavailable
Facility
$2489.28
No comparable office rate is available.
Portland
Oregon · 49190
Office
Unavailable
Facility
$2643.40
No comparable office rate is available.
Rest Of Oregon
Oregon · 49190
Office
Unavailable
Facility
$2528.25
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 49190
Office
Unavailable
Facility
$2767.19
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 49190
Office
Unavailable
Facility
$2567.31
No comparable office rate is available.
Puerto Rico
Puerto Rico · 49190
Office
Unavailable
Facility
$2641.89
No comparable office rate is available.
Rhode Island
Rhode Island · 49190
Office
Unavailable
Facility
$2652.68
No comparable office rate is available.
South Carolina
South Carolina · 49190
Office
Unavailable
Facility
$2536.14
No comparable office rate is available.
South Dakota**
South Dakota · 49190
Office
Unavailable
Facility
$2395.49
No comparable office rate is available.
Tennessee
Tennessee · 49190
Office
Unavailable
Facility
$2411.07
No comparable office rate is available.
Austin
Texas · 49190
Office
Unavailable
Facility
$2638.87
No comparable office rate is available.
Beaumont
Texas · 49190
Office
Unavailable
Facility
$2556.26
No comparable office rate is available.
Brazoria
Texas · 49190
Office
Unavailable
Facility
$2566.45
No comparable office rate is available.
Dallas
Texas · 49190
Office
Unavailable
Facility
$2600.06
No comparable office rate is available.
Fort Worth
Texas · 49190
Office
Unavailable
Facility
$2598.42
No comparable office rate is available.
Galveston
Texas · 49190
Office
Unavailable
Facility
$2585.44
No comparable office rate is available.
Houston
Texas · 49190
Office
Unavailable
Facility
$2787.51
No comparable office rate is available.
Rest Of Texas
Texas · 49190
Office
Unavailable
Facility
$2571.76
No comparable office rate is available.
Utah
Utah · 49190
Office
Unavailable
Facility
$2564.13
No comparable office rate is available.
Virginia
Virginia · 49190
Office
Unavailable
Facility
$2520.99
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 49190
Office
Unavailable
Facility
$2641.89
No comparable office rate is available.
Vermont
Vermont · 49190
Office
Unavailable
Facility
$2451.75
No comparable office rate is available.
Rest Of Washington
Washington · 49190
Office
Unavailable
Facility
$2607.47
No comparable office rate is available.
Seattle (King Cnty)
Washington · 49190
Office
Unavailable
Facility
$2800.30
No comparable office rate is available.
Wisconsin
Wisconsin · 49190
Office
Unavailable
Facility
$2358.15
No comparable office rate is available.
West Virginia
West Virginia · 49190
Office
Unavailable
Facility
$2715.00
No comparable office rate is available.
Wyoming**
Wyoming · 49190
Office
Unavailable
Facility
$2544.47
No comparable office rate is available.
See how rates vary across the country
49190 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 49190 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$2814.55
$2558.68 × 110% = $2814.55
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 49190 in Modesto.
PPRRVU2026_Oct_nonQPP.csv
5,779
- Code
- 49190
- Physician work
- 48.75
- Practice expense
- 19.26
- Malpractice
- 11.04
GPCI2026.csv
16
- Locality
- Modesto
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 48.75 | × 1.017 | 49.5787 |
| Practice expense | 19.26 | × 1.096 | 21.1090 |
| Malpractice | 11.04 | × 0.536 | 5.9174 |
| Total RVUs | 76.6051 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Modesto$2558.68
Open 49190 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 48.75 | 1.017 |
| Practice expense | 19.26 | 1.096 |
| Malpractice | 11.04 | 0.536 |
(48.75 × 1.017 + 19.26 × 1.096 + 11.04 × 0.536) × $33.4009 = $2558.68
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
49190 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $2558.68 | RVU26D |
| 2026-07-01 | Not available in this setting | $2558.68 | RVU26C |
| 2026-04-01 | Not available in this setting | $2558.68 | RVU26B |
| 2026-01-01 | Not available in this setting | $2558.68 | RVU26A |
| 2025-10-01 | Not available in this setting | $2744.91 | RVU25D |
| 2025-07-01 | Not available in this setting | $2744.91 | RVU25C |
| 2025-04-01 | Not available in this setting | $2744.91 | RVU25B |
| 2025-01-01 | Not available in this setting | $2744.91 | RVU25A |
49190 billing questions
How is 49190 distinguished from 49189?
49190 is for a treated lesion measuring more than 30 cm. Use 49189 for the 20.1-to-30-cm tier.
Is 49190 appropriate for a biopsy of an abdominal mass?
No. 49190 describes open excision or destruction, while 49180 describes biopsy of an abdominal mass. Choose based on the service actually performed.
What documentation supports the size tier?
The operative report should identify the tumor, cyst, or endometrioma, document its size, and describe the open excision or destruction.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is submitted; team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,77649187,,Opn exc/dstr ntra-abd 5.1-10,A,,27.93,11.95,NA,11.95,,6.42,46.30,46.30,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77749188,,Opn exc/dst ntra-abd 10.1-20,A,,33.15,14.67,NA,14.67,,7.64,55.46,55.46,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77849189,,Opn exc/dst ntra-abd 20.1-30,A,,39.00,16.29,NA,16.29,,9.00,64.29,64.29,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77949190,,Opn exc/dstr ntra-abd >30 cm,A,,48.75,19.26,NA,19.26,,11.04,79.05,79.05,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,78049215,,Excise sacral spine tumor,A,,36.86,15.04,NA,15.04,,8.08,59.98,59.98,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,78149250,,Excision of umbilicus,A,,8.78,6.13,NA,6.13,,2.10,17.01,17.01,0,090,0.09,0.81,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,78249255,,Removal of omentum,A,,12.25,7.40,NA,7.40,,2.86,22.51,22.51,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536