No office rate
The defect-size category is the same, but 49592 is for an incarcerated or strangulated hernia rather than a reducible one.
On this page
CMS RVU26D · Effective 2026-10-01
49591 Hernia repair Medicare reimbursement rates in Colorado
Reports initial repair of a reducible anterior abdominal hernia when the measured defect is under 3 cm, including open or minimally invasive approaches. Compare 49591 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 49591 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
$311.66
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.
General surgery
About 49591: Initial reducible small anterior abdominal hernia repair
Reports initial repair of a reducible anterior abdominal hernia when the measured defect is under 3 cm, including open or minimally invasive approaches.
This code describes an initial operation to repair a reducible anterior abdominal wall hernia with a defect measuring less than 3 cm. Typical examples include umbilical, epigastric, and ventral hernias. A general surgeon or other qualified surgeon may perform the repair in a hospital or ambulatory surgery setting, using an open, laparoscopic, or robotic approach. Mesh may be used as part of the repair.
Choose this code when the hernia is not a recurrence after prior repair, is reducible, and the operative documentation supports a defect under 3 cm. Record the hernia site, reducibility, prior repair history, and measured defect size. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple 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. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49591
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 RVU5.81 · 61%
- Practice expense (office) RVU2.15 · 23%
- Malpractice RVU1.49 · 16%
21.8K
Medicare services in 2024 · #1113 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.
49591 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Both are initial repairs of reducible anterior abdominal hernias; 49593 is for a defect measuring 3 to 10 cm.
No office rate
Both describe initial repair of a reducible hernia, but 49595 is for a defect larger than 10 cm.
Compare 49591 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
$311.66
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 49591 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,837
- Code
- 49591
- Physician work
- 5.81
- Practice expense
- 2.15
- Malpractice
- 1.49
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.81 | × 1.012 | 5.8797 |
| Practice expense | 2.15 | × 1.064 | 2.2876 |
| Malpractice | 1.49 | × 0.781 | 1.1637 |
| Total RVUs | 9.3310 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$311.66
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.81 | 1.012 |
| Practice expense | 2.15 | 1.064 |
| Malpractice | 1.49 | 0.781 |
(5.81 × 1.012 + 2.15 × 1.064 + 1.49 × 0.781) × $33.4009 = $311.66
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.
49591 billing questions
How is 49591 distinguished from 49592?
Both describe an initial anterior abdominal hernia repair for a defect under 3 cm. Use 49591 for a reducible hernia and 49592 when it is incarcerated or strangulated.
What documentation supports the size level?
The operative report should state the hernia site and the measured defect size. The defect must measure less than 3 cm for 49591.
Can mesh be billed separately with this repair?
Mesh may be used in the repair, but its placement is included in the hernia repair service represented by this code.
Should modifier 50 be appended for bilateral hernias?
No. Modifier 50 is inappropriate for this code under the CMS bilateral adjustment rule.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple procedure reduction.
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.
5,83449553,,Rpr fem hernia init blocked,A,,9.67,6.04,NA,6.04,,2.52,18.23,18.23,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83549555,,Rerepair fem hernia reduce,A,,9.16,5.85,NA,5.85,,2.46,17.47,17.47,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83649557,,Rerepair fem hernia blocked,A,,11.33,6.45,NA,6.45,,2.95,20.73,20.73,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83749591,,Rpr aa hrn 1st < 3 cm rdc,A,,5.81,2.15,NA,2.15,,1.49,9.45,9.45,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83849592,,Rpr aa hrn 1st < 3 ncr/strn,A,,8.25,2.67,NA,2.67,,2.16,13.08,13.08,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83949593,,Rpr aa hrn 1st 3-10 rdc,A,,10.00,3.11,NA,3.11,,2.61,15.72,15.72,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84049594,,Rpr aa hrn 1st 3-10 ncr/strn,A,,13.12,3.86,NA,3.86,,3.45,20.43,20.43,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,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