No office rate
Both codes cover recurrent anterior abdominal hernias under 3 cm. Choose 49614 for incarceration or strangulation and 49613 when the hernia is reducible.
On this page
CMS RVU26D · Effective 2026-10-01
49614 Hernia repair Medicare reimbursement rates in Delaware
Reports repair of a recurrent anterior abdominal hernia with a defect under 3 cm when incarcerated or strangulated, regardless of operative approach. Compare 49614 office and facility rates across CMS payment localities in Delaware.
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 49614 in Delaware?
Delaware 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
$515.69
1 of 1 localities have a supported rate.
Payment area: Delaware
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 49614: Recurrent incarcerated small abdominal hernia repair
Reports repair of a recurrent anterior abdominal hernia with a defect under 3 cm when incarcerated or strangulated, regardless of operative approach.
This code represents operative repair of a recurrent hernia in the anterior abdominal wall, such as an incisional, ventral, umbilical, epigastric, or Spigelian hernia. It applies when the total defect length is under 3 cm and the hernia is incarcerated or strangulated. A general surgeon typically performs the repair in a hospital operating room, using an open, laparoscopic, or robotic approach. Mesh placement, when performed as part of the repair, is included in the hernia service.
Choose the code from the operative findings: document the prior repair at the same site, the total defect length, and incarceration or strangulation. The approach does not change code selection. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one 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. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49614
- 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 RVU9.99 · 64%
- Practice expense (office) RVU3.09 · 20%
- Malpractice RVU2.61 · 17%
905
Medicare services in 2024 · #3037 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.
49614 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
Both cover recurrent incarcerated or strangulated hernias. 49616 is for a total defect length of 3–10 cm; 49614 is for under 3 cm.
No office rate
Both cover recurrent incarcerated or strangulated hernias. 49618 applies when the defect is over 10 cm, rather than under 3 cm.
No office rate
49622 is for repair of a parastomal hernia with incarceration or strangulation. Use 49614 for the specified recurrent anterior abdominal hernia outside that parastomal category.
Compare 49614 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
Delaware →
Office / nonfacility
Unavailable
Facility
$515.69
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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 49614 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
5,849
- Code
- 49614
- Physician work
- 9.99
- Practice expense
- 3.09
- Malpractice
- 2.61
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.99 | × 1.005 | 10.0399 |
| Practice expense | 3.09 | × 0.988 | 3.0529 |
| Malpractice | 2.61 | × 0.899 | 2.3464 |
| Total RVUs | 15.4393 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$515.69
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.99 | 1.005 |
| Practice expense | 3.09 | 0.988 |
| Malpractice | 2.61 | 0.899 |
(9.99 × 1.005 + 3.09 × 0.988 + 2.61 × 0.899) × $33.4009 = $515.69
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.
49614 billing questions
How does this differ from 49613?
Both describe repair of a recurrent anterior abdominal hernia with a defect under 3 cm. Use 49614 when the hernia is incarcerated or strangulated; 49613 is for a reducible hernia.
How is the size category selected?
Use the total length of the hernia defect documented at surgery. This code is for a defect under 3 cm.
Does the operative approach change the code?
No. The code applies whether the repair is open, laparoscopic, or robotic.
Can mesh placement be billed separately?
Mesh placement performed as part of the hernia repair is included in the service; it is not separately reported as a distinct mesh-placement service.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What same-session payment rule should billers expect?
If multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% multiple-procedure reduction.
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.
5,84649610,,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
5,85149616,,Rpr aa hrn rcr 3-10 ncr/strn,A,,15.16,4.34,NA,4.34,,3.95,23.45,23.45,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85249617,,Rpr aa hrn rcr > 10 rdc,A,,15.63,4.57,NA,4.57,,4.00,24.20,24.20,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503