Billing code 49189: Open lesion excisionMedicare rate & RVUs in Guam
Open abdominal excision or destruction of a 20.1-30 cm intra-abdominal tumor, cyst, or endometrioma is reported when operative treatment targets a lesion in this size band.
CMS doesn’t publish an office rate for 49189 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 49189 covers
This code describes open operative treatment by excision or destruction of a large intra-abdominal tumor, cyst, or endometrioma in the 20.1-30 cm size band. General surgeons, gynecologic surgeons, and surgical oncologists may perform the service in a hospital operating room. The operative report should establish the open approach, the lesion treated, the method of treatment, and its documented size.
Choose this level based on the treated lesion’s size; use a neighboring code when it falls in another size band. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 not appropriate for this code. 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.
49189 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $2,095.33 |
How the 49189 rate is calculated
Each of 49189’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 · 49189
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 39.00Practice expense 16.29Malpractice 9.00
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49189
49189 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49189
Open lesion excision
| 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 · 49189
Open lesion excision
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
49189 without 51 · national facility
$2,147.34
Open lesion excision
49189-51 · Second procedure: 50%
$1,073.67
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%).
49189 compared with similar codes
Compare codes
49189 vs 49188 vs 49190 vs 49180 vs 49185: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49188Open lesion treatment
- 49188 is for an open-treated intra-abdominal lesion measuring 10.1-20 cm; this code is for the next size band, 20.1-30 cm.
- 49190Open lesion surgery
- 49190 applies when the lesion is larger than 30 cm. Use this code for the 20.1-30 cm band.
- 49180Mass biopsy
- 49180 is for biopsy of an abdominal mass. This code describes open excision or destruction, not tissue sampling alone.
- 49185Fluid collection treatment
- 49185 describes sclerotherapy of a fluid collection. This code describes open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma.
49189 billing questions
How is this code distinguished from 49188 or 49190?
Use this code when the treated lesion measures 20.1-30 cm. Code 49188 covers the smaller 10.1-20 cm band, while 49190 is for lesions larger than 30 cm.
Can 49180 be reported for the same lesion?
49180 describes biopsy of an abdominal mass, while this code describes open excision or destruction. Report both only when the record supports distinct services rather than treating the same operative work as both sampling and definitive treatment.
Should modifier 50 be appended for bilateral disease?
No. The code’s descriptor and anatomy do not support modifier 50.
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.
What documentation supports the size-level selection?
Document the open approach, the tumor, cyst, or endometrioma treated, the treatment performed, and the lesion’s size supporting the 20.1-30 cm band.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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