No office rate
Both are nearby umbilical hernia repair choices. Use the code whose CPT-specific criteria match the operative documentation rather than choosing by site alone.
On this page
CMS RVU26D · Effective 2026-10-01
49611 Umbilical hernia repair Medicare reimbursement rates in Connecticut
Reports operative repair of an umbilical hernia, with code selection supported by the documented hernia and the repair performed. Compare 49611 office and facility rates across CMS payment localities in Connecticut.
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 49611 in Connecticut?
Connecticut 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
$629.09
1 of 1 localities have a supported rate.
Payment area: Connecticut
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 49611: Umbilical hernia surgical repair
Reports operative repair of an umbilical hernia, with code selection supported by the documented hernia and the repair performed.
This service is an operative repair of a hernia at the umbilicus, performed by a surgeon in an operating room or another setting equipped for surgery. The operation addresses the hernia defect; the operative report should identify the umbilical location and describe the repair. The code is specific to the umbilical hernia service, rather than a general abdominal-wall repair or a repair at another hernia site.
Select this code only when the documented service meets its CPT-specific criteria; do not infer those criteria from the anatomic site alone. The record should describe the hernia and the operative work sufficiently to distinguish this code from nearby hernia-repair options. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49611
- 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 RVU9.11 · 52%
- Practice expense (office) RVU6.13 · 35%
- Malpractice RVU2.43 · 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.
49611 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
This is a separate anterior abdominal hernia repair option. Select it only when the documented service meets its criteria, not simply because the repair involves the abdominal wall.
No office rate
This is another anterior abdominal hernia repair option with distinct criteria. The operative report should support the selected code rather than relying only on the umbilical location.
Compare 49611 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
Connecticut →
Office / nonfacility
Unavailable
Facility
$629.09
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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 49611 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
5,847
- Code
- 49611
- Physician work
- 9.11
- Practice expense
- 6.13
- Malpractice
- 2.43
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.11 | × 1.020 | 9.2922 |
| Practice expense | 6.13 | × 1.077 | 6.6020 |
| Malpractice | 2.43 | × 1.210 | 2.9403 |
| Total RVUs | 18.8345 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$629.09
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.11 | 1.02 |
| Practice expense | 6.13 | 1.077 |
| Malpractice | 2.43 | 1.21 |
(9.11 × 1.02 + 6.13 × 1.077 + 2.43 × 1.21) × $33.4009 = $629.09
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.
49611 billing questions
What documentation supports reporting this code?
Document the umbilical hernia and the operative repair performed. The record should provide enough detail to support this code rather than a nearby hernia-repair option.
Is modifier 50 appropriate for an umbilical hernia repair?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
How does the 90-day global period affect postoperative visits?
The global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the session are subject to the standard multiple-procedure reduction, with payment at 50%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How should this code be distinguished from nearby hernia-repair codes?
Confirm that the documented service meets this code’s CPT-specific criteria. Do not select it solely because the hernia is at the umbilicus; use the operative documentation to distinguish among the related choices.
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.
5,84449605,,Repair umbilical lesion,A,,84.91,26.81,NA,26.81,,22.74,134.46,134.46,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84549606,,Repair umbilical lesion,A,,18.53,8.27,NA,8.27,,4.94,31.74,31.74,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84649610,,Repair umbilical lesion,A,,10.64,6.36,NA,6.36,,2.84,19.84,19.84,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84749611,,Repair umbilical lesion,A,,9.11,6.13,NA,6.13,,2.43,17.67,17.67,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84849613,,Rpr aa hrn rcr < 3 rdc,A,,7.23,2.50,NA,2.50,,1.86,11.59,11.59,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84949614,,Rpr aa hrn rcr < 3 ncr/strn,A,,9.99,3.09,NA,3.09,,2.61,15.69,15.69,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85049615,,Rpr aa hrn rcr 3-10 rdc,A,,11.17,3.40,NA,3.40,,2.91,17.48,17.48,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808