Billing code 49521: Inguinal hernia repairMedicare rate & RVUs in Delaware
Open repair of a previously repaired inguinal hernia that is incarcerated or strangulated, reported when repeat surgery is required.
CMS doesn’t publish an office rate for 49521 in Delaware.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 49521 covers
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.
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 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $674.51 |
How the 49521 rate is calculated
Each of 49521’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 49521
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.19Practice expense 6.40Malpractice 2.92
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49521
49521 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49521
Inguinal hernia repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49521
Inguinal hernia repair
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
49521 without 50 · national facility
$685.05
Inguinal hernia repair
49521-50 · Bilateral: 150%
$1,027.58
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
49521 compared with similar codes
Compare codes
49521 vs 49520 vs 49501 vs 49507 vs 49557: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49520Inguinal hernia repair
- Both are for recurrent inguinal hernias. Choose 49521 for incarceration or strangulation and 49520 when the recurrent hernia is reducible.
- 49501Inguinal hernia repair
- This is an initial incarcerated inguinal hernia repair for a patient under age five. 49521 requires recurrence after a prior repair.
- 49507Inguinal hernia repair
- This is an initial incarcerated inguinal hernia repair for a patient age five or older. 49521 describes recurrent disease.
- 49557Femoral hernia repair
- Both describe recurrent hernia repair with incarceration or strangulation, but 49557 is for a femoral hernia rather than an inguinal hernia.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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