No office rate
Use 49615 for a recurrent 3-to-10-cm defect when reducible. Use 49616 when the hernia is incarcerated or strangulated.
On this page
CMS RVU26D · Effective 2026-10-01
49616 Hernia repair Medicare reimbursement rates in Nebraska
Repair of a recurrent anterior abdominal hernia measuring 3 to 10 cm when incarcerated or strangulated, by open, laparoscopic, or robotic approach. Compare 49616 office and facility rates across CMS payment localities in Nebraska.
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 49616 in Nebraska?
Nebraska has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$690.03
1 of 1 localities have a supported rate.
Payment area: Nebraska
One mapped payment locality.
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 49616: Recurrent Incarcerated Abdominal Hernia Repair
Repair of a recurrent anterior abdominal hernia measuring 3 to 10 cm when incarcerated or strangulated, by open, laparoscopic, or robotic approach.
Code 49616 represents operative repair of a recurrent anterior abdominal wall hernia with a total defect length from 3 through 10 cm when the hernia is incarcerated or strangulated. Relevant sites include ventral, incisional, umbilical, epigastric, and Spigelian hernias. General surgeons typically perform the repair in an operating room using open, laparoscopic, or robotic access; the code covers the approach and mesh placement when performed.
Select the code based on recurrence at the repaired site, incarceration or strangulation status, and the total length of the defect or defects repaired—not the incision length or access method. The operative report should document the prior repair, clinical findings establishing incarceration or strangulation, defect measurements, and the repair performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49616
- 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 RVU15.16 · 65%
- Practice expense (office) RVU4.34 · 19%
- Malpractice RVU3.95 · 17%
3.2K
Medicare services in 2024 · #2137 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.
49616 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
Both codes cover recurrent incarcerated or strangulated hernias; 49614 is for a defect under 3 cm, while 49616 is for 3 through 10 cm.
No office rate
Both codes cover recurrent incarcerated or strangulated hernias; 49618 is for a defect over 10 cm, while 49616 is for 3 through 10 cm.
No office rate
Both codes cover recurrent 3-to-10-cm defects. Use 49617 when reducible and 49616 when incarcerated or strangulated.
Compare 49616 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.
1 of 1 payment localities
Nebraska →
Office / nonfacility
Unavailable
Facility
$690.03
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 49616 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
5,851
- Code
- 49616
- Physician work
- 15.16
- Practice expense
- 4.34
- Malpractice
- 3.95
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.16 | × 1.000 | 15.1600 |
| Practice expense | 4.34 | × 0.923 | 4.0058 |
| Malpractice | 3.95 | × 0.378 | 1.4931 |
| Total RVUs | 20.6589 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nebraska$690.03
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.16 | 1 |
| Practice expense | 4.34 | 0.923 |
| Malpractice | 3.95 | 0.378 |
(15.16 × 1 + 4.34 × 0.923 + 3.95 × 0.378) × $33.4009 = $690.03
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
49616 billing questions
How is 49616 distinguished from 49615?
Both describe recurrent anterior abdominal hernia repair for a 3-to-10-cm defect. Use 49616 when the hernia is incarcerated or strangulated; 49615 is for a reducible hernia.
What documentation supports reporting 49616?
Document the prior repair at the site, findings that establish incarceration or strangulation, the total length of the defect or defects, and the operative repair performed.
Can the repair approach determine the code?
No. Open, laparoscopic, and robotic approaches are included in this code; select the code by recurrence, defect length, and reducible versus incarcerated or strangulated status.
Can mesh placement be billed separately?
Mesh placement, when performed as part of the hernia repair, is included in the repair service.
How does the multiple-procedure reduction affect 49616?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the remaining procedures are subject to the standard 50% reduction.
Can modifier 50 be used for bilateral repair?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
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.
5,84849613,,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
5,85449621,,Rpr parastomal hernia rdc,A,,13.36,3.94,NA,3.94,,3.16,20.46,20.46,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068