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CMS RVU26D · Effective 2026-10-01

49610 Gastroschisis repair Medicare reimbursement rates in Massachusetts

Reports operative repair of gastroschisis in a newborn when the abdominal contents are reduced and the abdominal wall is closed in a primary repair. Compare 49610 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 49610 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

$660.36–$708.02

2 of 2 localities have a supported rate.

Lowest: Rest Of Massachusetts

Highest: Metropolitan Boston

A spread of $47.66 per service.

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.

Find 49610 in your payment locality →

Pediatric surgery

About 49610: Newborn gastroschisis repair

Reports operative repair of gastroschisis in a newborn when the abdominal contents are reduced and the abdominal wall is closed in a primary repair.

This code describes operative treatment of gastroschisis in a newborn: the surgeon returns the exposed abdominal contents to the abdomen and closes the abdominal wall defect. Pediatric surgeons typically perform the repair in a hospital operating room shortly after birth. A primary closure is used when the defect can be closed at the initial repair; staged management uses a different code.

Report the code when the operative record supports primary repair of gastroschisis, including the newborn’s diagnosis and the closure performed. The 90-day global period includes the day-before preoperative visit and related postoperative care during the following 90 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this midline defect. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

CMS billing rules for 49610

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 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 RVU10.64 · 54%
  • Practice expense (office) RVU6.36 · 32%
  • Malpractice RVU2.84 · 14%

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.

49610 compared with similar codes

Office rates for Massachusetts, from the same CMS release.

49611

Umbilical hernia repair

Umbilical site

No office rate

49610 describes primary gastroschisis repair. Choose 49611 when the operative plan uses staged closure.

49600

Umbilical repair

No office rate

49600 is in the omphalocele repair group. Gastroschisis is a separate congenital defect and is reported with its own repair code.

Compare 49610 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

Office and facility base rates · shared scale starting at $0

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49610 billing questions

How does this differ from 49611?

Use 49610 for primary repair of gastroschisis. Use 49611 when the operative treatment is a staged closure.

Is this the code for omphalocele repair?

No. Gastroschisis and omphalocele are distinct congenital abdominal wall defects; codes 49600, 49605, and 49606 are in the omphalocele repair group.

What documentation supports reporting 49610?

Document the newborn’s gastroschisis and the operative reduction and primary abdominal wall closure. The record should make clear that the procedure was not a staged closure.

Can modifier 50 be used?

No. The defect is midline, so modifier 50 is inappropriate.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, with other procedures subject to the standard multiple-procedure reduction.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. 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.

RVUs for 49610PPRRVU2026_Oct_nonQPP.csv, line 5,846 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet