No office rate
Both describe recurrent inguinal hernia repair. Choose 49520 when the hernia is reducible; 49521 is for an incarcerated or strangulated hernia.
On this page
CMS RVU26D · Effective 2026-10-01
49520 Inguinal hernia repair Medicare reimbursement rates in Massachusetts
Open repair of a previously repaired inguinal hernia when the recurrent defect is reducible, reported for operative treatment of the recurrence. Compare 49520 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 49520 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
$606.54–$650.46
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.
Hernia repair
About 49520: Recurrent reducible inguinal hernia repair
Open repair of a previously repaired inguinal hernia when the recurrent defect is reducible, reported for operative treatment of the recurrence.
Code 49520 describes operative repair of a recurrent inguinal hernia that is reducible, meaning the protruding contents can be returned rather than remaining trapped. It applies when the hernia has returned at a site previously repaired, not to a first-time hernia. General surgeons commonly perform this open repair in a hospital operating room or ambulatory surgery center; a laparoscopic repair is coded separately.
Document the prior repair or history establishing recurrence, the inguinal location, reducibility, and the procedure performed. The service has a 90-day global period: the day-before preoperative visit and related postoperative care through day 90 are included. For bilateral repair, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49520
- 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 RVU9.74 · 53%
- Practice expense (office) RVU5.91 · 32%
- Malpractice RVU2.56 · 14%
4.9K
Medicare services in 2024 · #1885 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.
49520 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
49505 describes initial reducible inguinal hernia repair in a patient age five or older. Use 49520 when the hernia has recurred after a prior repair.
No office rate
49651 is the laparoscopic option for recurrent inguinal hernia repair. Code 49520 describes open repair.
No office rate
49555 is for recurrent reducible femoral hernia repair. Code 49520 is for an inguinal hernia.
Compare 49520 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
$650.46
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$606.54
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49520 billing questions
How does 49520 differ from 49505?
49520 is for a reducible inguinal hernia that has recurred after a prior repair. 49505 describes an initial reducible inguinal hernia in a patient age five or older.
When should 49521 be used instead?
Use 49521 for recurrent inguinal hernia repair when the hernia is incarcerated or strangulated, rather than reducible.
Does 49520 describe open or laparoscopic repair?
49520 describes open repair. Laparoscopic repair of a recurrent inguinal hernia is reported with 49651.
What documentation supports reporting recurrent repair?
Document that the hernia is at a previously repaired inguinal site, that it is reducible, and what repair was performed. A first-time hernia does not meet the recurrence criterion.
How is bilateral repair handled?
When both sides are repaired in the same session, modifier 50 is paid at 150% under the CMS bilateral rule.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. 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.
5,82649501,,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
5,83149525,,Repair ing hernia sliding,A,,8.71,5.61,NA,5.61,,2.28,16.60,16.60,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83249540,,Repair lumbar hernia,A,,10.47,6.10,NA,6.10,,2.70,19.27,19.27,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00