No office rate
Both are for recurrent defects under 3 cm. Choose 49613 for a reducible hernia and 49614 for an incarcerated or strangulated hernia.
On this page
CMS RVU26D · Effective 2026-10-01
49613 Abdominal hernia repair Medicare reimbursement rates in Indiana
Reports repair of a recurrent, reducible anterior abdominal hernia when the total length of the repaired defect or defects is under 3 cm. Compare 49613 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 49613 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
$349.09
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.
Hernia surgery
About 49613: Recurrent reducible abdominal hernia repair under 3 cm
Reports repair of a recurrent, reducible anterior abdominal hernia when the total length of the repaired defect or defects is under 3 cm.
This code describes repair of a previously repaired anterior abdominal hernia that is reducible and has a total defect length under 3 cm. These repairs are commonly performed by general surgeons in a hospital or ambulatory surgery setting. The code covers recognized anterior abdominal hernia sites, such as incisional, ventral, umbilical, epigastric, and Spigelian hernias, and includes mesh or other prosthesis implantation when performed. The repair may use an open, laparoscopic, or robotic approach.
Select the code using the hernia’s recurrence status, reducibility, and total length of the defect or defects repaired. The operative report should establish the prior repair, reducibility, measured defect length, and repair performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49613
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 RVU7.23 · 62%
- Practice expense (office) RVU2.50 · 22%
- Malpractice RVU1.86 · 16%
1.3K
Medicare services in 2024 · #2797 by national volume
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.
49613 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
This code is for recurrent, reducible defects under 3 cm; 49615 is for the same recurrence and reducibility status when total defect length is 3–10 cm.
No office rate
Both describe reducible anterior abdominal hernia repair under 3 cm. 49613 is for a recurrent hernia; 49591 is for an initial repair.
Compare 49613 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
$349.09
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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 49613 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,848
- Code
- 49613
- Physician work
- 7.23
- Practice expense
- 2.50
- Malpractice
- 1.86
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.23 | × 1.000 | 7.2300 |
| Practice expense | 2.50 | × 0.927 | 2.3175 |
| Malpractice | 1.86 | × 0.486 | 0.9040 |
| Total RVUs | 10.4515 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$349.09
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.23 | 1 |
| Practice expense | 2.5 | 0.927 |
| Malpractice | 1.86 | 0.486 |
(7.23 × 1 + 2.5 × 0.927 + 1.86 × 0.486) × $33.4009 = $349.09
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.
49613 billing questions
How is this code distinguished from 49614?
Both describe recurrent anterior abdominal hernia repair for a defect under 3 cm. Use 49613 when the hernia is reducible; 49614 is for an incarcerated or strangulated hernia.
Does the code include mesh placement?
Yes. Mesh or another prosthesis is included in the hernia repair code when implanted during the repair.
What documentation supports the under-3-cm level?
Document the total length of the defect or defects repaired, along with the operative findings that establish recurrence and reducibility.
Should modifier 50 be used for a bilateral repair?
No. Modifier 50 is inappropriate for this code; CMS does not apply a bilateral adjustment to it.
How are other procedures in the same session paid?
CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to the other procedures.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
5,84549606,,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
5,84949614,,Rpr aa hrn rcr < 3 ncr/strn,A,,9.99,3.09,NA,3.09,,2.61,15.69,15.69,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85049615,,Rpr aa hrn rcr 3-10 rdc,A,,11.17,3.40,NA,3.40,,2.91,17.48,17.48,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85149616,,Rpr aa hrn rcr 3-10 ncr/strn,A,,15.16,4.34,NA,4.34,,3.95,23.45,23.45,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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