No office rate
Choose 49613 for an initial, reducible repair of a 3–10 cm anterior abdominal hernia. Code 49615 applies when the hernia has recurred after a prior repair.
On this page
CMS RVU26D · Effective 2026-10-01
49615 Hernia repair Medicare reimbursement rates in Maine
Reports repair of a recurrent, reducible anterior abdominal hernia measuring 3–10 cm, using an open, laparoscopic, or robotic approach. Compare 49615 office and facility rates across CMS payment localities in Maine.
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 49615 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$538.02–$546.96
2 of 2 localities have a supported rate.
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 49615: Recurrent reducible abdominal hernia repair
Reports repair of a recurrent, reducible anterior abdominal hernia measuring 3–10 cm, using an open, laparoscopic, or robotic approach.
A surgeon repairs a hernia that has returned after a prior repair at the same site. The code applies to an anterior abdominal hernia, such as an incisional, ventral, umbilical, epigastric, or Spigelian hernia, when the defect is recurrent, reducible, and 3–10 cm. The repair may be performed through an open incision or by a laparoscopic or robotic approach. These operations are commonly performed in a hospital or ambulatory surgery center.
Select the code using the operative findings: document the prior repair, the defect’s measured size, and that the hernia was reducible. Mesh or another prosthesis used as part of the repair is included in the hernia-repair service. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. 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. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49615
- 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 RVU11.17 · 64%
- Practice expense (office) RVU3.40 · 19%
- Malpractice RVU2.91 · 17%
2.9K
Medicare services in 2024 · #2190 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.
49615 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
Both codes describe recurrent hernias in the 3–10 cm range; 49616 is for an incarcerated or strangulated hernia, while 49615 is for a reducible hernia.
No office rate
Both describe recurrent, reducible hernias. Use 49615 for a 3–10 cm defect and 49617 for a defect larger than 10 cm.
Compare 49615 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$538.02
Southern Maine →
Office / nonfacility
Unavailable
Facility
$546.96
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49615 billing questions
How is this code distinguished from 49613?
Both describe a reducible anterior abdominal hernia measuring 3–10 cm. Use 49615 for a recurrent hernia and 49613 for an initial repair.
What documentation supports reporting 49615?
The operative report should establish that the hernia is recurrent, document the defect measurement, and describe its reducibility. It should also identify the repair performed.
Can mesh placement be reported separately?
Mesh or another prosthesis used in the hernia repair is included in the repair service; do not report it separately as an additional mesh-implantation service.
Does the code vary by open, laparoscopic, or robotic approach?
No. The code covers the qualifying repair regardless of whether the surgeon uses an open, laparoscopic, or robotic approach.
Can modifier 50 be used for a bilateral repair?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The code has a 0-day global period, including same-day preoperative and postoperative care.
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.
5,84749611,,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
5,85249617,,Rpr aa hrn rcr > 10 rdc,A,,15.63,4.57,NA,4.57,,4.00,24.20,24.20,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85349618,,Rpr aa hrn rcr > 10 ncr/strn,A,,22.10,6.09,NA,6.09,,5.69,33.88,33.88,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00