No office rate
Use 39503 for acute traumatic diaphragmatic hernia repair; 39540 identifies repair of a chronic traumatic hernia.
On this page
CMS RVU26D · Effective 2026-10-01
39540 Diaphragm hernia repair Medicare reimbursement rates in Guam
Repair a chronic diaphragmatic hernia caused by trauma, typically by reducing herniated abdominal contents and closing the diaphragmatic defect. Compare 39540 office and facility rates across CMS payment localities in Guam.
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 39540 in Guam?
Guam 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
$798.13
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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.
Thoracic surgery
About 39540: Chronic traumatic diaphragmatic hernia repair
Repair a chronic diaphragmatic hernia caused by trauma, typically by reducing herniated abdominal contents and closing the diaphragmatic defect.
This operation repairs a diaphragmatic hernia that developed after trauma and is treated in the chronic phase. The surgeon exposes the diaphragm through an appropriate operative approach, returns displaced abdominal contents to the abdomen, and closes the defect. It is generally performed by a thoracic or general surgeon in a hospital operating room. The distinguishing feature is the chronic traumatic origin; an acute traumatic hernia and a nontraumatic hernia are reported with different codes.
Report the service when the operative documentation supports repair of a chronic, trauma-related diaphragmatic hernia. The 90-day global period includes the day-before preoperative visit and related postoperative care during that period. 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 50% 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 39540
- 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 RVU14.21 · 58%
- Practice expense (office) RVU6.68 · 27%
- Malpractice RVU3.61 · 15%
134
Medicare services in 2024 · #4643 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.
39540 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
Use 39541 when the diaphragmatic hernia is nontraumatic. A chronic traumatic cause supports 39540.
No office rate
39501 describes repair of a diaphragm laceration. It is not the hernia-repair code for a chronic traumatic diaphragmatic hernia.
No office rate
43281 is for laparoscopic repair of a paraesophageal hernia. 39540 is for repair of a chronic traumatic diaphragmatic hernia.
Compare 39540 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$798.13
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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 39540 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
4,783
- Code
- 39540
- Physician work
- 14.21
- Practice expense
- 6.68
- Malpractice
- 3.61
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.21 | × 1.000 | 14.2100 |
| Practice expense | 6.68 | × 1.137 | 7.5952 |
| Malpractice | 3.61 | × 0.579 | 2.0902 |
| Total RVUs | 23.8954 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$798.13
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.21 | 1 |
| Practice expense | 6.68 | 1.137 |
| Malpractice | 3.61 | 0.579 |
(14.21 × 1 + 6.68 × 1.137 + 3.61 × 0.579) × $33.4009 = $798.13
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.
39540 billing questions
How is 39540 distinguished from 39503?
39540 is for repair of a chronic traumatic diaphragmatic hernia. Use 39503 for repair of an acute traumatic diaphragmatic hernia.
When is 39541 a better fit?
39541 describes repair of a nontraumatic diaphragmatic hernia. The documented cause of the hernia distinguishes it from the chronic traumatic hernia reported with 39540.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this diaphragmatic hernia repair.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. 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.
4,78039499,,Unlisted px mediastinum,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4,78139501,,Repair diaphragm laceration,A,,13.63,7.31,NA,7.31,,3.31,24.25,24.25,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,78239503,,Repair of diaphragm hernia,A,,106.19,27.29,NA,27.29,,26.77,160.25,160.25,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,78339540,,Repair of diaphragm hernia,A,,14.21,6.68,NA,6.68,,3.61,24.50,24.50,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,78439541,,Repair of diaphragm hernia,A,,15.36,7.25,NA,7.25,,3.98,26.59,26.59,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,78539545,,Revision of diaphragm,A,,14.30,8.24,NA,8.24,,3.59,26.13,26.13,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,78639560,,Resect diaphragm simple,A,,12.73,6.96,NA,6.96,,3.03,22.72,22.72,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014