No office rate
Both describe open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma. Select 49190 for a lesion over 30 cm and 49189 for one measuring 20.1 to 30 cm.
On this page
CMS RVU26D · Effective 2026-10-01
49190 Open lesion surgery Medicare reimbursement rates in Indiana
Reports open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma when its documented size exceeds 30 cm. Compare 49190 office and facility rates across CMS payment localities in Indiana.
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 49190 in Indiana?
Indiana 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
$2403.84
1 of 1 localities have a supported rate.
Payment area: Indiana
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.
General surgery
About 49190: Open removal or destruction of a very large intra-abdominal lesion
Reports open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma when its documented size exceeds 30 cm.
This code covers an open operation to remove or destroy an intra-abdominal tumor, cyst, or endometrioma measuring more than 30 cm. A surgeon may perform the procedure through an open abdominal approach in a hospital operating room. The lesion may be benign or malignant; the code’s size tier and open approach distinguish the service, not the lesion’s pathology.
Select this tier using the documented size of the treated lesion; the operative report should support the lesion type, its measurement, and the open excision or destruction performed. The code has a 90-day global period, including 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 others at 50%. An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 49190
- 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 RVU48.75 · 62%
- Practice expense (office) RVU19.26 · 24%
- Malpractice RVU11.04 · 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.
49190 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
49188 is the open excision or destruction tier for lesions measuring 10.1 to 20 cm; 49190 is reserved for lesions over 30 cm.
$159.38
49180 describes biopsy sampling of an abdominal mass. Use 49190 when the surgeon performs open excision or destruction of the qualifying large lesion.
Compare 49190 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
Indiana →
Office / nonfacility
Unavailable
Facility
$2403.84
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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 49190 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,779
- Code
- 49190
- Physician work
- 48.75
- Practice expense
- 19.26
- Malpractice
- 11.04
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 48.75 | × 1.000 | 48.7500 |
| Practice expense | 19.26 | × 0.927 | 17.8540 |
| Malpractice | 11.04 | × 0.486 | 5.3654 |
| Total RVUs | 71.9695 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$2403.84
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 48.75 | 1 |
| Practice expense | 19.26 | 0.927 |
| Malpractice | 11.04 | 0.486 |
(48.75 × 1 + 19.26 × 0.927 + 11.04 × 0.486) × $33.4009 = $2403.84
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.
49190 billing questions
How is 49190 distinguished from 49189?
49190 is for a treated lesion measuring more than 30 cm. Use 49189 for the 20.1-to-30-cm tier.
Is 49190 appropriate for a biopsy of an abdominal mass?
No. 49190 describes open excision or destruction, while 49180 describes biopsy of an abdominal mass. Choose based on the service actually performed.
What documentation supports the size tier?
The operative report should identify the tumor, cyst, or endometrioma, document its size, and describe the open excision or destruction.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is submitted; team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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.
5,77649187,,Opn exc/dstr ntra-abd 5.1-10,A,,27.93,11.95,NA,11.95,,6.42,46.30,46.30,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77749188,,Opn exc/dst ntra-abd 10.1-20,A,,33.15,14.67,NA,14.67,,7.64,55.46,55.46,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77849189,,Opn exc/dst ntra-abd 20.1-30,A,,39.00,16.29,NA,16.29,,9.00,64.29,64.29,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77949190,,Opn exc/dstr ntra-abd >30 cm,A,,48.75,19.26,NA,19.26,,11.04,79.05,79.05,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,78049215,,Excise sacral spine tumor,A,,36.86,15.04,NA,15.04,,8.08,59.98,59.98,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,78149250,,Excision of umbilicus,A,,8.78,6.13,NA,6.13,,2.10,17.01,17.01,0,090,0.09,0.81,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,78249255,,Removal of omentum,A,,12.25,7.40,NA,7.40,,2.86,22.51,22.51,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915