No office rate
Both describe initial, reducible anterior abdominal hernia repair. Choose 49593 for total defect length from 3 cm through 10 cm; 49595 is for a length over 10 cm.
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CMS RVU26D · Effective 2026-10-01
49595 Abdominal hernia repair Medicare reimbursement rates in New Jersey
Repair of an initial, reducible anterior abdominal wall hernia with total defect length over 10 cm, regardless of open, laparoscopic, or robotic approach. Compare 49595 office and facility rates across CMS payment localities in New Jersey.
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 49595 in New Jersey?
New Jersey 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
$746.21–$762.44
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 49595: Initial large reducible abdominal hernia repair
Repair of an initial, reducible anterior abdominal wall hernia with total defect length over 10 cm, regardless of open, laparoscopic, or robotic approach.
49595 represents operative repair of an initial anterior abdominal wall hernia when the total length of the defect or defects exceeds 10 cm and the hernia is reducible. The category includes ventral, incisional, umbilical, epigastric, and Spigelian hernias. The code covers open, laparoscopic, and robotic repair, so the approach does not determine code selection. Surgeons commonly perform this repair in hospital or ambulatory surgery settings; mesh or other prosthetic reinforcement, when used as part of the repair, is included in the service.
Select the code using the total defect length, reducibility, and whether the repair is initial rather than recurrent. The operative report should support those details, including the measured defect length. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures subject to the standard reduction are performed in one session, the highest-valued procedure is paid in full and the others at 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49595
- 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 RVU13.59 · 64%
- Practice expense (office) RVU4.03 · 19%
- Malpractice RVU3.47 · 16%
5.3K
Medicare services in 2024 · #1837 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.
49595 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
49594 covers a nonreducible or strangulated initial hernia measuring 3 cm through 10 cm. 49595 is reducible and over 10 cm.
No office rate
Both apply to an initial repair over 10 cm. Use 49595 when the hernia is reducible and 49596 when it is nonreducible or strangulated.
No office rate
49617 is for a recurrent reducible anterior abdominal hernia over 10 cm; 49595 is for an initial repair with the same size and reducibility.
Compare 49595 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
Northern Nj →
Office / nonfacility
Unavailable
Facility
$762.44
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$746.21
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49595 billing questions
How is 49595 distinguished from 49593?
49595 is for a total defect length over 10 cm. 49593 applies when the total length is 3 cm through 10 cm and the hernia is reducible.
When should 49596 be used instead?
Use 49596 for an initial anterior abdominal hernia over 10 cm that is nonreducible or strangulated. 49595 is for a reducible hernia in that size category.
Does the surgical approach change code selection?
No. The code covers open, laparoscopic, and robotic repair; select it based on initial versus recurrent status, reducibility, and total defect length.
Can mesh placement be billed separately?
Mesh or other prosthetic reinforcement used as part of the hernia repair is included in the service represented by 49595.
What should the operative note document?
Document that the repair is initial, that the hernia is reducible, and the total measured length of the defect or defects.
How are assistant and co-surgeon services handled?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and 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.
5,83849592,,Rpr aa hrn 1st < 3 ncr/strn,A,,8.25,2.67,NA,2.67,,2.16,13.08,13.08,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83949593,,Rpr aa hrn 1st 3-10 rdc,A,,10.00,3.11,NA,3.11,,2.61,15.72,15.72,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84049594,,Rpr aa hrn 1st 3-10 ncr/strn,A,,13.12,3.86,NA,3.86,,3.45,20.43,20.43,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84149595,,Rpr aa hrn 1st > 10 rdc,A,,13.59,4.03,NA,4.03,,3.47,21.09,21.09,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84249596,,Rpr aa hrn 1st > 10 ncr/strn,A,,18.20,5.11,NA,5.11,,4.73,28.04,28.04,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84349600,,Repair umbilical lesion,A,,11.26,6.80,NA,6.80,,3.01,21.07,21.07,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84449605,,Repair umbilical lesion,A,,84.91,26.81,NA,26.81,,22.74,134.46,134.46,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00