Billing code 49616: Hernia repairMedicare rate & RVUs in Florida
Repair of a recurrent anterior abdominal hernia measuring 3 to 10 cm when incarcerated or strangulated, by open, laparoscopic, or robotic approach.
CMS doesn’t publish an office rate for 49616 in Florida.
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 49616 covers
Code 49616 represents operative repair of a recurrent anterior abdominal wall hernia with a total defect length from 3 through 10 cm when the hernia is incarcerated or strangulated. Relevant sites include ventral, incisional, umbilical, epigastric, and Spigelian hernias. General surgeons typically perform the repair in an operating room using open, laparoscopic, or robotic access; the code covers the approach and mesh placement when performed.
Select the code based on recurrence at the repaired site, incarceration or strangulation status, and the total length of the defect or defects repaired—not the incision length or access method. The operative report should document the prior repair, clinical findings establishing incarceration or strangulation, defect measurements, and the repair performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Assistant-at-surgery payment may be made; 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.
Where 49616 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $891.74 |
| Miami | Unavailable | $990.92 |
| Rest Of Florida | Unavailable | $843.24 |
How the 49616 rate is calculated
Each of 49616’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 · 49616
RVUs × geographic indexes × conversion factor
Work15.16
15.16 RVUs× 1.000 GPCI
Practice expense4.34
4.34 RVUs× 1.000 GPCI
Malpractice3.95
3.95 RVUs× 1.000 GPCI
Adjusted RVUs
23.4500
Conversion factor
$33.4009
Medicare rate
$783.25
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49616
The CMS indicators that decide how 49616 is paid alongside other services.
CMS payment indicators · 49616
Hernia repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49616 without 51 · national facility
$783.25
Hernia repair
49616-51 · Second procedure: 50%
$391.63
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
49616 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49615Hernia repair
- Use 49615 for a recurrent 3-to-10-cm defect when reducible. Use 49616 when the hernia is incarcerated or strangulated.
- 49614Hernia repair
- Both codes cover recurrent incarcerated or strangulated hernias; 49614 is for a defect under 3 cm, while 49616 is for 3 through 10 cm.
- 49618Abdominal hernia repair
- Both codes cover recurrent incarcerated or strangulated hernias; 49618 is for a defect over 10 cm, while 49616 is for 3 through 10 cm.
- 49617Abdominal hernia repair
- Both codes cover recurrent 3-to-10-cm defects. Use 49617 when reducible and 49616 when incarcerated or strangulated.
49616 billing questions
How is 49616 distinguished from 49615?
Both describe recurrent anterior abdominal hernia repair for a 3-to-10-cm defect. Use 49616 when the hernia is incarcerated or strangulated; 49615 is for a reducible hernia.
What documentation supports reporting 49616?
Document the prior repair at the site, findings that establish incarceration or strangulation, the total length of the defect or defects, and the operative repair performed.
Can the repair approach determine the code?
No. Open, laparoscopic, and robotic approaches are included in this code; select the code by recurrence, defect length, and reducible versus incarcerated or strangulated status.
Can mesh placement be billed separately?
Mesh placement, when performed as part of the hernia repair, is included in the repair service.
How does the multiple-procedure reduction affect 49616?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the remaining procedures are subject to the standard 50% reduction.
Can modifier 50 be used for bilateral repair?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
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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