Billing code 49591: Hernia repairMedicare rate & RVUs in Massachusetts
Reports initial repair of a reducible anterior abdominal hernia when the measured defect is under 3 cm, including open or minimally invasive approaches.
CMS doesn’t publish an office rate for 49591 in Massachusetts.
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 49591 covers
This code describes an initial operation to repair a reducible anterior abdominal wall hernia with a defect measuring less than 3 cm. Typical examples include umbilical, epigastric, and ventral hernias. A general surgeon or other qualified surgeon may perform the repair in a hospital or ambulatory surgery setting, using an open, laparoscopic, or robotic approach. Mesh may be used as part of the repair.
Choose this code when the hernia is not a recurrence after prior repair, is reducible, and the operative documentation supports a defect under 3 cm. Record the hernia site, reducibility, prior repair history, and measured defect size. 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 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 49591 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | Unavailable | $332.05 |
| Rest Of Massachusetts | Unavailable | $312.45 |
How the 49591 rate is calculated
Each of 49591’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 · 49591
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.81Practice expense 2.15Malpractice 1.49
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49591
The CMS indicators that decide how 49591 is paid alongside other services.
CMS payment indicators · 49591
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
49591 without 51 · national facility
$315.64
Hernia repair
49591-51 · Second procedure: 50%
$157.82
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%).
49591 compared with similar codes
Compare codes
49591 vs 49592 vs 49593 vs 49595: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49592Abdominal hernia repair
- The defect-size category is the same, but 49592 is for an incarcerated or strangulated hernia rather than a reducible one.
- 49593Abdominal hernia repair
- Both are initial repairs of reducible anterior abdominal hernias; 49593 is for a defect measuring 3 to 10 cm.
- 49595Abdominal hernia repair
- Both describe initial repair of a reducible hernia, but 49595 is for a defect larger than 10 cm.
49591 billing questions
How is 49591 distinguished from 49592?
Both describe an initial anterior abdominal hernia repair for a defect under 3 cm. Use 49591 for a reducible hernia and 49592 when it is incarcerated or strangulated.
What documentation supports the size level?
The operative report should state the hernia site and the measured defect size. The defect must measure less than 3 cm for 49591.
Can mesh be billed separately with this repair?
Mesh may be used in the repair, but its placement is included in the hernia repair service represented by this code.
Should modifier 50 be appended for bilateral hernias?
No. Modifier 50 is inappropriate for this code under the CMS bilateral adjustment rule.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple procedure reduction.
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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