Billing code 49615: Hernia repairMedicare rate & RVUs in Illinois
Reports repair of a recurrent, reducible anterior abdominal hernia measuring 3–10 cm, using an open, laparoscopic, or robotic approach.
CMS doesn’t publish an office rate for 49615 in Illinois.
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 49615 covers
A surgeon repairs a hernia that has returned after a prior repair at the same site. The code applies to an anterior abdominal hernia, such as an incisional, ventral, umbilical, epigastric, or Spigelian hernia, when the defect is recurrent, reducible, and 3–10 cm. The repair may be performed through an open incision or by a laparoscopic or robotic approach. These operations are commonly performed in a hospital or ambulatory surgery center.
Select the code using the operative findings: document the prior repair, the defect’s measured size, and that the hernia was reducible. Mesh or another prosthesis used as part of the repair is included in the hernia-repair service. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. 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 inappropriate. Assistant-at-surgery services 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.
Where 49615 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $712.90 |
| East St. Louis | Unavailable | $673.32 |
| Rest Of Illinois | Unavailable | $628.69 |
| Suburban Chicago | Unavailable | $664.56 |
How the 49615 rate is calculated
Each of 49615’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 · 49615
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.17Practice expense 3.40Malpractice 2.91
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49615
The CMS indicators that decide how 49615 is paid alongside other services.
CMS payment indicators · 49615
Hernia repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49615 without 51 · national facility
$583.85
Hernia repair
49615-51 · Second procedure: 50%
$291.93
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%).
49615 compared with similar codes
Compare codes
49615 vs 49613 vs 49616 vs 49617: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49613Abdominal hernia repair
- Choose 49613 for an initial, reducible repair of a 3–10 cm anterior abdominal hernia. Code 49615 applies when the hernia has recurred after a prior repair.
- 49616Hernia repair
- Both codes describe recurrent hernias in the 3–10 cm range; 49616 is for an incarcerated or strangulated hernia, while 49615 is for a reducible hernia.
- 49617Abdominal hernia repair
- Both describe recurrent, reducible hernias. Use 49615 for a 3–10 cm defect and 49617 for a defect larger than 10 cm.
49615 billing questions
How is this code distinguished from 49613?
Both describe a reducible anterior abdominal hernia measuring 3–10 cm. Use 49615 for a recurrent hernia and 49613 for an initial repair.
What documentation supports reporting 49615?
The operative report should establish that the hernia is recurrent, document the defect measurement, and describe its reducibility. It should also identify the repair performed.
Can mesh placement be reported separately?
Mesh or another prosthesis used in the hernia repair is included in the repair service; do not report it separately as an additional mesh-implantation service.
Does the code vary by open, laparoscopic, or robotic approach?
No. The code covers the qualifying repair regardless of whether the surgeon uses an open, laparoscopic, or robotic approach.
Can modifier 50 be used for a bilateral repair?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The code has a 0-day global period, including same-day preoperative and 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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