Billing code 39503: Diaphragm hernia repairMedicare rate & RVUs in Nevada
Reports operative repair of a diaphragmatic hernia, including neonatal cases, such as repair of a congenital defect allowing abdominal organs into the chest.
CMS doesn’t publish an office rate for 39503 in Nevada.
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 39503 covers
This code covers operative repair of a diaphragmatic hernia, most commonly a congenital defect treated in a newborn. The surgeon returns displaced abdominal contents to the abdomen and repairs the opening in the diaphragm. The operation is generally performed in a hospital operating room by a thoracic or pediatric surgeon, often with neonatal surgical and anesthesia teams involved. The code’s scope includes chest tube insertion when performed as part of the repair.
Select this code for diaphragmatic hernia repair in the included neonatal context, rather than repair of a traumatic diaphragmatic hernia in a non-neonate. The operative report should establish the hernia, the repair performed, and the patient’s relevant clinical context. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care for 90 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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.
39503 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | Unavailable | $5,204.08 |
How the 39503 rate is calculated
Each of 39503’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 · 39503
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 106.19Practice expense 27.29Malpractice 26.77
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 39503
39503 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 39503
Diaphragm hernia repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 39503
Diaphragm hernia repair
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
39503 without 51 · national facility
$5,352.49
Diaphragm hernia repair
39503-51 · Second procedure: 50%
$2,676.25
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%).
39503 compared with similar codes
Compare codes
39503 vs 39540 vs 39541 vs 39501: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 39540Diaphragm hernia repair
- 39503 covers the neonatal-inclusive diaphragmatic hernia repair. Use 39540 for traumatic diaphragmatic hernia repair in a patient other than a neonate.
- 39541Diaphragm repair
- This code is for traumatic diaphragmatic hernia repair with prosthesis or mesh in a patient other than a neonate; 39503 is the neonatal-inclusive hernia repair code.
- 39501Diaphragm repair
- 39501 applies to repair of a traumatic diaphragm laceration. It is not the hernia-repair code represented by 39503.
39503 billing questions
When should 39503 be chosen over 39540?
Use 39503 for the diaphragmatic hernia repair covered by the neonatal-inclusive code. Code 39540 describes repair of a traumatic diaphragmatic hernia in a patient other than a neonate.
Is chest tube insertion included in 39503?
Chest tube insertion is within the stated scope of 39503 when performed as part of the diaphragmatic hernia repair. Do not report a separate chest tube service solely for that included step.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code’s descriptor or anatomy.
What global period applies?
The code has a 90-day global period. The day-before preoperative visit and 90 days of related postoperative care are included.
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.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are subject to a 50% reduction.
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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