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CMS RVU26D · Effective 2026-10-01

49189 Open lesion excision Medicare reimbursement rates in Hawaii

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. Compare 49189 office and facility rates across CMS payment localities in Hawaii.

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 49189 in Hawaii?

Hawaii 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

$2095.33

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.

Find 49189 in your payment locality →

Abdominal surgery

About 49189: Open intra-abdominal lesion excision, 20.1-30 cm

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.

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.

CMS billing rules for 49189

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 RVU39.00 · 61%
  • Practice expense (office) RVU16.29 · 25%
  • Malpractice RVU9.00 · 14%

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 compared with similar codes

Office rates for Hawaii, from the same CMS release.

49188

Open lesion treatment

10.1–20 cm lesion

No office rate

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.

49190

Open lesion surgery

More than 30 cm

No office rate

49190 applies when the lesion is larger than 30 cm. Use this code for the 20.1-30 cm band.

49180

Mass biopsy

Percutaneous abdominal mass

$182.59

49180 is for biopsy of an abdominal mass. This code describes open excision or destruction, not tissue sampling alone.

49185

Fluid collection treatment

Percutaneous sclerotherapy

$1,355.65

49185 describes sclerotherapy of a fluid collection. This code describes open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma.

Compare 49189 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

Office and facility base rates · shared scale starting at $0

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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 49189 in Hawaii, Guam.

PPRRVU2026_Oct_nonQPP.csv

5,778

Code
49189
Physician work
39.00
Practice expense
16.29
Malpractice
9.00

GPCI2026.csv

46

Locality
Hawaii, Guam
Physician work
1.000
Practice expense
1.137
Malpractice
0.579
Facility calculation for 49189 in Hawaii, Guam
ComponentRVULocality factorAdjusted
Physician work39.00× 1.00039.0000
Practice expense16.29× 1.13718.5217
Malpractice9.00× 0.5795.2110
Total RVUs62.7327
Conversion factor× 33.4009

Facility rate, Hawaii, Guam$2095.33

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.
Explore RVUs, geographic factors and the full formula

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work391
Practice expense16.291.137
Malpractice90.579

(39 × 1 + 16.29 × 1.137 + 9 × 0.579) × $33.4009 = $2095.33

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.

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 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.

RVUs for 49189PPRRVU2026_Oct_nonQPP.csv, line 5,778 (RVU26D)
Geographic factors for Hawaii, GuamGPCI2026.csv, line 46 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet