Billing code 49188: Open lesion treatmentMedicare rate & RVUs in Guam
Open removal or destruction of an intra-abdominal tumor, cyst, or endometrioma measuring 10.1–20 cm, reported when the operative approach is open.
CMS doesn’t publish an office rate for 49188 in Guam.
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 49188 covers
Code 49188 represents open surgical removal or destruction of an intra-abdominal tumor, cyst, or endometrioma in the 10.1–20 cm size band. A general or gynecologic surgeon, surgical oncologist, or other surgeon may perform the procedure during an abdominal operation. The operative record should identify the lesion and site, document its measured size, and describe therapeutic excision or destruction rather than diagnostic sampling alone.
Choose this size tier based on the treated lesion’s documented measurement; use neighboring family codes for other size bands. The day-before preoperative visit and 90 days of related postoperative care are included. When other procedures occur in the same session, the highest-valued procedure is paid in full and additional procedures at 50%. Modifier 50 is inappropriate for this anatomy. An assistant may be paid; co-surgeons require 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.
49188 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,812.11 |
How the 49188 rate is calculated
Each of 49188’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 · 49188
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 33.15Practice expense 14.67Malpractice 7.64
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49188
49188 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49188
Open lesion treatment
| 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) | 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. |
| 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 · 49188
Open lesion treatment
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 51 · payment effect
With and without the modifier
49188 without 51 · national facility
$1,852.41
Open lesion treatment
49188-51 · Second procedure: 50%
$926.21
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%).
49188 compared with similar codes
Compare codes
49188 vs 49187 vs 49189 vs 49180: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49187Open lesion surgery
- Use 49187 for the same type of open intra-abdominal lesion treatment when the lesion falls in the 5.1–10 cm band; 49188 is for 10.1–20 cm.
- 49189Open lesion excision
- Use 49189 when the lesion falls in the 20.1–30 cm band. The procedure type is similar, but the documented size places it in a larger tier than 49188.
- 49180Mass biopsy
- 49180 represents biopsy of an abdominal mass for diagnostic sampling. Choose 49188 when the open procedure removes or destroys the lesion in the specified size band.
49188 billing questions
How is 49188 distinguished from nearby size-level codes?
Use 49188 for an intra-abdominal tumor, cyst, or endometrioma in the 10.1–20 cm size band. Codes 49187 and 49189 cover the adjacent smaller and larger bands.
Can 49188 be reported for a needle biopsy of an abdominal mass?
No. 49188 describes open therapeutic removal or destruction; 49180 is the related code for biopsy of an abdominal mass.
Are related postoperative visits included?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the 90-day global period.
How is 49188 paid when other procedures are performed in the same session?
The highest-valued procedure is paid in full, with other procedures subject to the standard multiple-procedure reduction and paid at 50%.
May 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.
Should modifier 50 be used for lesions on both sides?
No. The anatomy or descriptor makes modifier 50 inappropriate for this service.
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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