No office rate
Both describe initial reducible inguinal hernia repair; 49500 is for a patient younger than five, while 49505 is for a patient age five or older.
On this page
CMS RVU26D · Effective 2026-10-01
49505 Inguinal hernia repair Medicare reimbursement rates in Massachusetts
Open repair of a first-time, reducible inguinal hernia in a patient age five or older, typically performed by a surgeon in an operating room. Compare 49505 office and facility rates across CMS payment localities in Massachusetts.
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 49505 in Massachusetts?
Massachusetts 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
$507.83–$546.11
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 49505: Initial reducible inguinal hernia repair
Open repair of a first-time, reducible inguinal hernia in a patient age five or older, typically performed by a surgeon in an operating room.
This code represents open surgery for a primary inguinal hernia that is reducible in a patient age five or older. The surgeon exposes the groin, addresses the hernia contents, and repairs the inguinal defect. General surgeons commonly perform the operation in an operating room for adults and older children with a first-time, reducible groin hernia.
Select the code based on the patient’s age, inguinal site, initial-repair status, and reducibility. Document these details and the operative findings. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 49505
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU7.76 · 51%
- Practice expense (office) RVU5.40 · 36%
- Malpractice RVU2.05 · 13%
39.2K
Medicare services in 2024 · #879 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.
49505 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
This code is for a reducible initial hernia in a patient age five or older. Code 49507 describes an initial hernia that is incarcerated or strangulated in that age group.
No office rate
Use 49505 for an initial reducible inguinal hernia. Code 49520 is for repair of a recurrent, reducible inguinal hernia.
Compare 49505 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
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$546.11
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$507.83
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49505 billing questions
When is this code appropriate instead of 49500?
Use this code for an initial, reducible inguinal hernia in a patient age five or older. Code 49500 is the corresponding initial reducible repair for a younger child.
How does an incarcerated hernia change code selection?
For an initial inguinal hernia in a patient age five or older that is incarcerated or strangulated rather than reducible, compare code 49507.
Are related postoperative visits separately reported?
Related postoperative care for 90 days is included in the global period. The day-before preoperative visit is also included.
How is a bilateral repair reported?
Report modifier 50 for a bilateral procedure. CMS pays the bilateral service at 150%.
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 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.
5,82449496,,Rpr ing hernia baby blocked,A,,9.18,6.21,NA,6.21,,2.46,17.85,17.85,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82549500,,Rpr ing hernia init reduce,A,,5.69,5.15,NA,5.15,,1.51,12.35,12.35,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82649501,,Rpr ing hernia init blocked,A,,9.13,5.99,NA,5.99,,2.44,17.56,17.56,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82749505,,Prp i/hern init reduc >5 yr,A,,7.76,5.40,NA,5.40,,2.05,15.21,15.21,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82849507,,Prp i/hern init block >5 yr,A,,8.86,5.83,NA,5.83,,2.32,17.01,17.01,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82949520,,Rerepair ing hernia reduce,A,,9.74,5.91,NA,5.91,,2.56,18.21,18.21,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83049521,,Rerepair ing hernia blocked,A,,11.19,6.40,NA,6.40,,2.92,20.51,20.51,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00