CPT code 49596: Abdominal hernia repair2026 Medicare rate & RVUs in Kansas
Reports initial repair of an anterior abdominal hernia with a defect over 10 cm that is incarcerated or strangulated, using any surgical approach.
CMS doesn’t publish an office rate for 49596 in Kansas.
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 49596 covers
This code covers initial repair of an anterior abdominal hernia, such as a ventral, incisional, umbilical, or epigastric hernia, when the hernia is incarcerated or strangulated and the defect exceeds 10 cm. General surgeons commonly perform the repair in a hospital or ambulatory surgical setting. The code includes open, laparoscopic, and robotic approaches, and includes mesh or another prosthesis when used.
Select the code from the operative findings: document that the repair is initial, the hernia’s incarcerated or strangulated status, and the defect measurement. When multiple defects are repaired, document their measurements to support the applicable size category. Same-day preoperative and postoperative care is included in the 0-day global period. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require 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.
49596 in Kansas
| Payment locality | Office | Facility |
|---|---|---|
| Kansas | Unavailable | $841.81 |
How the 49596 rate is calculated
Each of 49596’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 · 49596
RVUs × geographic indexes × conversion factor
Work18.20
18.20 RVUs× 1.000 GPCI
Practice expense5.11
5.11 RVUs× 1.000 GPCI
Malpractice4.73
4.73 RVUs× 1.000 GPCI
Adjusted RVUs
28.0400
Conversion factor
$33.4009
Medicare rate
$936.56
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49596
The CMS indicators that decide how 49596 is paid alongside other services.
CMS payment indicators · 49596
Abdominal 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
49596 without 51 · national facility
$936.56
Abdominal hernia repair
49596-51 · Second procedure: 50%
$468.28
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%).
49596 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49595Abdominal hernia repair
- Use 49595 when the initial anterior abdominal hernia is reducible. Code 49596 when it is incarcerated or strangulated; both are for defects over 10 cm.
- 49594Hernia repair
- This code is for an initial incarcerated or strangulated repair with a 3-to-10-cm defect. Code 49596 applies when the defect is over 10 cm.
- 49618Abdominal hernia repair
- Use 49618 for a recurrent incarcerated or strangulated anterior abdominal hernia with a defect over 10 cm. Code 49596 describes an initial repair.
49596 billing questions
How is this code distinguished from 49595?
Both describe initial repair of an anterior abdominal hernia with a defect over 10 cm. Use 49596 for an incarcerated or strangulated hernia and 49595 when it is reducible.
Does the repair approach change code selection?
No. This code covers open, laparoscopic, and robotic repair; select it based on initial versus recurrent status, defect size, and reducibility or strangulation.
Can mesh be billed separately with this repair?
Mesh or another prosthesis used for the hernia repair is included in the code.
What documentation supports the over-10-cm category?
The operative report should record the defect measurement and the incarcerated or strangulated status. Document measurements for multiple repaired defects to support the selected size category.
Should modifier 50 be used for bilateral hernias?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How are other same-session procedures paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures in the same session 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 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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