CPT code 49600: Umbilical repair2026 Medicare rate & RVUs in Maine
Surgical repair of an umbilical hernia, reported for the specific repair circumstances defined by this code’s complete CPT descriptor and documentation.
CMS doesn’t publish an office rate for 49600 in Maine.
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 49600 covers
This code represents operative repair of an umbilical hernia. The surgeon addresses the defect at the navel; the service is typically performed by a general surgeon in an operating room or another surgical setting. The operative report should identify the umbilical defect and describe the repair performed. Use the full CPT descriptor to confirm that this code’s specific criteria fit the case rather than relying on the abbreviated CMS label alone.
The code has a 90-day global period, which includes 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 other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery 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 49600 pays more and less in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Maine | Unavailable | $647.58 |
| Southern Maine | Unavailable | $664.61 |
How the 49600 rate is calculated
Each of 49600’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 · 49600
RVUs × geographic indexes × conversion factor
Work11.26
11.26 RVUs× 1.000 GPCI
Practice expense6.80
6.80 RVUs× 1.000 GPCI
Malpractice3.01
3.01 RVUs× 1.000 GPCI
Adjusted RVUs
21.0700
Conversion factor
$33.4009
Medicare rate
$703.76
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49600
49600 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49600
Umbilical repair
| 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) | 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. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49600
Umbilical repair
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 51 · payment effect
With and without the modifier
49600 without 51 · national facility
$703.76
Umbilical repair
49600-51 · Second procedure: 50%
$351.88
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%).
49600 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49605Umbilical hernia repair
- Both have the same abbreviated CMS label. Select between them using each code’s complete CPT descriptor and the documented repair circumstances.
- 49606Omphalocele repair
- The CMS short descriptors are identical; the full CPT descriptors determine which code matches the case.
- 49610Gastroschisis repair
- This is another nearby umbilical repair code. Compare its complete descriptor with the operative report rather than choosing from the abbreviated labels.
49600 billing questions
What documentation supports reporting this code?
The operative report should establish that the hernia is at the umbilicus and describe the repair. Confirm that the case meets the complete CPT descriptor’s criteria before selecting this code.
Does the code include routine postoperative care?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does the multiple-procedure rule affect payment?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.
Can modifier 50 be reported?
No. The CMS facts specify that bilateral adjustment does not apply and modifier 50 is inappropriate for this code.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; 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 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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