Billing code 49495: Hernia repairMedicare rate & RVUs in Guam
Surgical repair of an initial, reducible inguinal hernia in an infant younger than 6 months, selected by age and hernia status.
CMS doesn’t publish an office rate for 49495 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 49495 covers
This service is the operative repair of an initial inguinal hernia in an infant younger than 6 months when the hernia is reducible. Pediatric surgeons commonly perform the procedure in a hospital operating room. The operative report should establish the patient’s age, the inguinal hernia diagnosis, its reducibility, and the repair performed.
Choose this code for the reducible infant presentation, not the code for an incarcerated hernia or the distinct premature-infant category. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. If multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. For bilateral repair, modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with 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.
49495 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $396.33 |
How the 49495 rate is calculated
Each of 49495’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 · 49495
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.05Practice expense 4.29Malpractice 1.62
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49495
49495 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49495
Hernia repair
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 49495
Hernia repair
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 50 · payment effect
With and without the modifier
49495 without 50 · national facility
$399.47
Hernia repair
49495-50 · Bilateral: 150%
$599.21
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
49495 compared with similar codes
Compare codes
49495 vs 49496 vs 49491 vs 49500: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49496Inguinal hernia repair
- Both codes describe inguinal hernia repair in an infant younger than 6 months; 49495 is for a reducible hernia, while 49496 is for an incarcerated hernia.
- 49491Inguinal hernia repair
- 49491 identifies the premature-infant category. Use 49495 for the reducible infant case when the distinct premature-infant category does not apply.
- 49500Inguinal hernia repair
- 49500 is for a reducible initial inguinal hernia in a child age 6 months to younger than 5 years; 49495 is for an infant younger than 6 months.
49495 billing questions
How does 49495 differ from 49496?
49495 is for a reducible hernia in an infant younger than 6 months. Use 49496 when the hernia is incarcerated.
When should 49491 be considered instead?
49491 is the distinct code for a premature infant with a reducible inguinal hernia. Document the patient’s status and the facts supporting code selection.
How is a bilateral repair reported?
Report modifier 50 for a bilateral procedure; CMS pays it at 150%.
Are related postoperative visits separately reported?
Related postoperative care during the 90-day global period is included, along with the day-before preoperative visit.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation.
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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