No office rate
Both are for recurrent inguinal hernias. Choose 49521 for incarceration or strangulation and 49520 when the recurrent hernia is reducible.
On this page
CMS RVU26D · Effective 2026-10-01
49521 Inguinal hernia repair Medicare reimbursement rates in Colorado
Open repair of a previously repaired inguinal hernia that is incarcerated or strangulated, reported when repeat surgery is required. Compare 49521 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 49521 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
$681.86
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.
Hernia surgery
About 49521: Recurrent incarcerated inguinal hernia repair
Open repair of a previously repaired inguinal hernia that is incarcerated or strangulated, reported when repeat surgery is required.
This code represents operative repair of an inguinal hernia that has recurred after an earlier repair and is incarcerated or strangulated. Incarceration means the hernia contents are trapped and cannot be returned; strangulation involves compromised blood supply. A surgeon releases the trapped contents as needed and repairs the recurrent defect. General surgeons commonly perform the operation in a hospital or ambulatory surgery setting.
Report this code when the operative record supports both a prior inguinal hernia repair and incarceration or strangulation at the current operation. The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period. For bilateral repair, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49521
- 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 RVU11.19 · 55%
- Practice expense (office) RVU6.40 · 31%
- Malpractice RVU2.92 · 14%
1.9K
Medicare services in 2024 · #2517 by national volume
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.
49521 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
This is an initial incarcerated inguinal hernia repair for a patient under age five. 49521 requires recurrence after a prior repair.
No office rate
This is an initial incarcerated inguinal hernia repair for a patient age five or older. 49521 describes recurrent disease.
No office rate
Both describe recurrent hernia repair with incarceration or strangulation, but 49557 is for a femoral hernia rather than an inguinal hernia.
Compare 49521 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
$681.86
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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 49521 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,830
- Code
- 49521
- Physician work
- 11.19
- Practice expense
- 6.40
- Malpractice
- 2.92
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.19 | × 1.012 | 11.3243 |
| Practice expense | 6.40 | × 1.064 | 6.8096 |
| Malpractice | 2.92 | × 0.781 | 2.2805 |
| Total RVUs | 20.4144 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$681.86
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.19 | 1.012 |
| Practice expense | 6.4 | 1.064 |
| Malpractice | 2.92 | 0.781 |
(11.19 × 1.012 + 6.4 × 1.064 + 2.92 × 0.781) × $33.4009 = $681.86
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.
49521 billing questions
How does this differ from 49520?
Both describe repair of a recurrent inguinal hernia. Use 49521 when the recurrent hernia is incarcerated or strangulated; 49520 describes a reducible recurrent hernia.
Can this code be used for a first-time inguinal hernia?
No. The documentation must establish that the inguinal hernia has recurred after a prior repair. Initial repairs are represented by other codes, with selection based on the clinical circumstances.
What documentation supports reporting 49521?
Document the prior inguinal hernia repair and the current incarcerated or strangulated condition, along with operative findings and the repair performed.
How is bilateral repair reported?
For bilateral procedures, report modifier 50; CMS pays the bilateral procedure at 150%.
Is postoperative care separately reported during the global period?
The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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.
5,82749505,,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
5,83049521,,Rerepair ing hernia blocked,A,,11.19,6.40,NA,6.40,,2.92,20.51,20.51,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83149525,,Repair ing hernia sliding,A,,8.71,5.61,NA,5.61,,2.28,16.60,16.60,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83249540,,Repair lumbar hernia,A,,10.47,6.10,NA,6.10,,2.70,19.27,19.27,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83349550,,Rpr rem hernia init reduce,A,,8.77,5.65,NA,5.65,,2.30,16.72,16.72,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,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