Billing code 55540: Hernia and varicocele surgeryMedicare rate & RVUs in Illinois
Reports an inguinal hernia operation combined with treatment of spermatic veins, such as for a varicocele, during the same surgical service.
CMS doesn’t publish an office rate for 55540 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 55540 covers
This code represents an operation that addresses an inguinal hernia and spermatic veins in the same surgical service. The vein treatment may involve excision or ligation for a varicocele. Urologists and surgeons typically perform the procedure in an operating room, with the operative report identifying the hernia repair and the spermatic-vein work performed.
Select the code when the documented service includes both parts of the combined procedure; a varicocele operation without hernia repair is a different service. The report should support the treated side, the hernia work, and the spermatic-vein treatment. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures at 50%. A bilateral procedure reported with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; 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 55540 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 | $636.40 |
| East St. Louis | Unavailable | $597.43 |
| Rest Of Illinois | Unavailable | $563.51 |
| Suburban Chicago | Unavailable | $603.02 |
How the 55540 rate is calculated
Each of 55540’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 · 55540
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.09Practice expense 5.92Malpractice 2.16
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 55540
55540 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 55540
Hernia and varicocele surgery
| 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) | 1 | Not paid (statutory restriction). |
| 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 55540
Hernia and varicocele surgery
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
55540 without 50 · national facility
$540.09
Hernia and varicocele surgery
55540-50 · Bilateral: 150%
$810.14
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).
55540 compared with similar codes
Compare codes
55540 vs 55530 vs 55535 vs 55550 vs 49505: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 55530Varicocele repair
- 55530 is for varicocele excision or spermatic-vein ligation without the combined hernia repair. This code represents the hernia-and-vein service.
- 55535Varicocele surgery
- Both involve hernia and spermatic-vein work. Check the full descriptors and operative report to distinguish the service represented by 55535 from this code.
- 55550Varicocele surgery
- 55550 describes laparoscopic spermatic-vein ligation for varicocele; it is not the combined hernia-and-vein service represented here.
- 49505Inguinal hernia repair
- 49505 is an inguinal hernia repair code without the spermatic-vein treatment that characterizes this combined service.
55540 billing questions
How does this differ from 55530?
55530 describes varicocele excision or spermatic-vein ligation without the hernia repair included in this combined service. Use the code supported by the operative work performed.
Should the varicocele procedure also be reported separately?
The combined service includes treatment of the spermatic veins with the hernia operation. Do not separately report a code for that same vein work.
How does 55535 differ from this code?
Both codes involve hernia and spermatic-vein work. Compare the full code descriptors with the operative report to determine whether the documented service matches 55535's varicocele-focused wording or this code's hernia-and-vein service.
What documentation supports reporting this code?
The operative report should describe both the inguinal hernia repair and the spermatic-vein procedure, including the treated side and the work performed.
How are bilateral services handled?
When the procedure is bilateral and reported with modifier 50, CMS pays it at 150%.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeon payment is allowed 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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