No office rate
Use 49500 for an initial reducible inguinal hernia in a child under 5. Use 49501 when the hernia is incarcerated or strangulated.
On this page
CMS RVU26D · Effective 2026-10-01
49501 Inguinal hernia repair Medicare reimbursement rates in Colorado
Reports initial surgical repair of an incarcerated or strangulated inguinal hernia in a child aged 6 months to younger than 5 years. Compare 49501 office and facility rates across CMS payment localities in Colorado.
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.
What does Medicare pay for 49501 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$585.14
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Pediatric surgery
About 49501: Initial incarcerated inguinal hernia repair in a young child
Reports initial surgical repair of an incarcerated or strangulated inguinal hernia in a child aged 6 months to younger than 5 years.
This code describes initial surgical repair of an inguinal hernia that is incarcerated or strangulated in a child aged 6 months to younger than 5 years. A pediatric or general surgeon typically performs the repair in an operating room, addressing the hernia and its contents through a surgical approach. The defining distinctions are the child’s age, an initial rather than recurrent repair, and documentation that the hernia is incarcerated or strangulated rather than reducible.
The operative report should support the hernia’s location and status, the patient’s age, and that this is the first repair. CMS assigns 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 other procedures at 50%. For bilateral repair reported with modifier 50, CMS pays at 150%. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49501
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU9.13 · 52%
- Practice expense (office) RVU5.99 · 34%
- Malpractice RVU2.44 · 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.
49501 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Both codes describe an initial incarcerated or strangulated inguinal hernia repair; 49507 is for patients aged 5 years or older, while 49501 is for children aged 6 months to younger than 5 years.
No office rate
49521 describes repair of a recurrent incarcerated inguinal hernia. Choose 49501 when the incarcerated or strangulated hernia is being repaired for the first time in a child under 5.
Compare 49501 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Colorado →
Office / nonfacility
Unavailable
Facility
$585.14
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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 49501 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,826
- Code
- 49501
- Physician work
- 9.13
- Practice expense
- 5.99
- Malpractice
- 2.44
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.13 | × 1.012 | 9.2396 |
| Practice expense | 5.99 | × 1.064 | 6.3734 |
| Malpractice | 2.44 | × 0.781 | 1.9056 |
| Total RVUs | 17.5186 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$585.14
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.13 | 1.012 |
| Practice expense | 5.99 | 1.064 |
| Malpractice | 2.44 | 0.781 |
(9.13 × 1.012 + 5.99 × 1.064 + 2.44 × 0.781) × $33.4009 = $585.14
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.
49501 billing questions
How does this code differ from 49500?
Both describe an initial inguinal hernia repair in a child younger than 5 years. Use 49501 when the hernia is incarcerated or strangulated; 49500 is for a reducible hernia.
When is 49507 used instead?
49507 describes an initial incarcerated or strangulated inguinal hernia repair in a patient aged 5 years or older. This code is for a child aged 6 months to younger than 5 years.
What documentation supports reporting 49501?
The operative record should identify the inguinal hernia as incarcerated or strangulated, establish that the repair is initial, and support the patient’s age.
How are bilateral repairs handled?
For bilateral repair reported with modifier 50, CMS pays at 150%. The record should support repair on both sides.
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 services may be paid. Co-surgeon payment requires supporting documentation; CMS does not permit team-surgery payment 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 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.
5,82349495,,Rpr ing hernia baby reduc,A,,6.05,4.29,NA,4.29,,1.62,11.96,11.96,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82449496,,Rpr ing hernia baby blocked,A,,9.18,6.21,NA,6.21,,2.46,17.85,17.85,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82549500,,Rpr ing hernia init reduce,A,,5.69,5.15,NA,5.15,,1.51,12.35,12.35,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82649501,,Rpr ing hernia init blocked,A,,9.13,5.99,NA,5.99,,2.44,17.56,17.56,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82749505,,Prp i/hern init reduc >5 yr,A,,7.76,5.40,NA,5.40,,2.05,15.21,15.21,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82849507,,Prp i/hern init block >5 yr,A,,8.86,5.83,NA,5.83,,2.32,17.01,17.01,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82949520,,Rerepair ing hernia reduce,A,,9.74,5.91,NA,5.91,,2.56,18.21,18.21,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899