49600
No office rateUmbilical repair
Use 49600 for a newborn omphalocele in the small size category; 49606 represents the giant category.
On this page
CMS RVU26D · Effective 2026-10-01
49606 Omphalocele repair Medicare reimbursement rates in Idaho
Reports surgical repair of a giant omphalocele in a newborn, a congenital abdominal wall defect requiring operative closure. Compare 49606 office and facility rates across CMS payment localities in Idaho.
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 49606 in Idaho?
Idaho 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
$951.09
1 of 1 localities have a supported rate.
Payment area: Idaho
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.
Congenital surgery
About 49606: Giant omphalocele repair in a newborn
Reports surgical repair of a giant omphalocele in a newborn, a congenital abdominal wall defect requiring operative closure.
This code identifies operative repair of a giant omphalocele in a newborn. An omphalocele is a congenital abdominal wall defect in which abdominal contents protrude through the umbilical area within a sac. Pediatric or neonatal surgeons perform the repair, typically in an operating room. The operative report should establish that the condition is an omphalocele and describe the defect and repair sufficiently to support the giant category.
Select this code by the omphalocele size category, not by treating the condition as an acquired umbilical hernia or as gastroschisis. The code has a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49606
- 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 RVU18.53 · 58%
- Practice expense (office) RVU8.27 · 26%
- Malpractice RVU4.94 · 16%
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.
49606 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
Use 49605 for the large omphalocele category. The documented defect category distinguishes it from the giant category reported with 49606.
No office rate
49610 is for gastroschisis repair, not omphalocele repair. Base code selection on the congenital defect documented and treated.
Compare 49606 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
Idaho →
Office / nonfacility
Unavailable
Facility
$951.09
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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 49606 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
5,845
- Code
- 49606
- Physician work
- 18.53
- Practice expense
- 8.27
- Malpractice
- 4.94
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.53 | × 1.000 | 18.5300 |
| Practice expense | 8.27 | × 0.920 | 7.6084 |
| Malpractice | 4.94 | × 0.473 | 2.3366 |
| Total RVUs | 28.4750 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$951.09
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18.53 | 1 |
| Practice expense | 8.27 | 0.92 |
| Malpractice | 4.94 | 0.473 |
(18.53 × 1 + 8.27 × 0.92 + 4.94 × 0.473) × $33.4009 = $951.09
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.
49606 billing questions
How is 49606 distinguished from 49600 and 49605?
These codes distinguish omphalocele repairs by the size category documented for the newborn’s defect. Use 49606 for the giant category, not the small or large categories.
Is an omphalocele the same as gastroschisis for coding?
No. An omphalocele and gastroschisis are distinct congenital abdominal wall defects; this code is for giant omphalocele repair.
Does the 90-day global period include related postoperative care?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can modifier 50 be reported for a bilateral repair?
No. Bilateral adjustment is not appropriate for this code.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
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.
5,84249596,,Rpr aa hrn 1st > 10 ncr/strn,A,,18.20,5.11,NA,5.11,,4.73,28.04,28.04,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84349600,,Repair umbilical lesion,A,,11.26,6.80,NA,6.80,,3.01,21.07,21.07,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84449605,,Repair umbilical lesion,A,,84.91,26.81,NA,26.81,,22.74,134.46,134.46,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84549606,,Repair umbilical lesion,A,,18.53,8.27,NA,8.27,,4.94,31.74,31.74,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84649610,,Repair umbilical lesion,A,,10.64,6.36,NA,6.36,,2.84,19.84,19.84,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84749611,,Repair umbilical lesion,A,,9.11,6.13,NA,6.13,,2.43,17.67,17.67,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84849613,,Rpr aa hrn rcr < 3 rdc,A,,7.23,2.50,NA,2.50,,1.86,11.59,11.59,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772