No office rate
Use 49595 when the initial anterior abdominal hernia is reducible. Code 49596 when it is incarcerated or strangulated; both are for defects over 10 cm.
On this page
CMS RVU26D · Effective 2026-10-01
49596 Abdominal hernia repair Medicare reimbursement rates in New York
Reports initial repair of an anterior abdominal hernia with a defect over 10 cm that is incarcerated or strangulated, using any surgical approach. Compare 49596 office and facility rates across CMS payment localities in New York.
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 49596 in New York?
New York has 5 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 5 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$881.11–$1143.12
5 of 5 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.
Where 49596 pays more and less in New York
General surgery
About 49596: Initial large incarcerated abdominal hernia repair
Reports initial repair of an anterior abdominal hernia with a defect over 10 cm that is incarcerated or strangulated, using any surgical approach.
This code covers initial repair of an anterior abdominal hernia, such as a ventral, incisional, umbilical, or epigastric hernia, when the hernia is incarcerated or strangulated and the defect exceeds 10 cm. General surgeons commonly perform the repair in a hospital or ambulatory surgical setting. The code includes open, laparoscopic, and robotic approaches, and includes mesh or another prosthesis when used.
Select the code from the operative findings: document that the repair is initial, the hernia’s incarcerated or strangulated status, and the defect measurement. When multiple defects are repaired, document their measurements to support the applicable size category. Same-day preoperative and postoperative care is included in the 0-day global period. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 49596
- 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 RVU18.20 · 65%
- Practice expense (office) RVU5.11 · 18%
- Malpractice RVU4.73 · 17%
5.3K
Medicare services in 2024 · #1839 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.
49596 compared with similar codes
Office rates for New York, from the same CMS release.
No office rate
This code is for an initial incarcerated or strangulated repair with a 3-to-10-cm defect. Code 49596 applies when the defect is over 10 cm.
No office rate
Use 49618 for a recurrent incarcerated or strangulated anterior abdominal hernia with a defect over 10 cm. Code 49596 describes an initial repair.
Compare 49596 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.
5 of 5 payment localities
Manhattan →
Office / nonfacility
Unavailable
Facility
$1095.70
Nyc Suburbs/Long Island →
Office / nonfacility
Unavailable
Facility
$1143.12
Poughkpsie/N Nyc Suburbs →
Office / nonfacility
Unavailable
Facility
$1013.31
Queens →
Office / nonfacility
Unavailable
Facility
$1076.36
Rest Of New York →
Office / nonfacility
Unavailable
Facility
$881.11
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49596 billing questions
How is this code distinguished from 49595?
Both describe initial repair of an anterior abdominal hernia with a defect over 10 cm. Use 49596 for an incarcerated or strangulated hernia and 49595 when it is reducible.
Does the repair approach change code selection?
No. This code covers open, laparoscopic, and robotic repair; select it based on initial versus recurrent status, defect size, and reducibility or strangulation.
Can mesh be billed separately with this repair?
Mesh or another prosthesis used for the hernia repair is included in the code.
What documentation supports the over-10-cm category?
The operative report should record the defect measurement and the incarcerated or strangulated status. Document measurements for multiple repaired defects to support the selected size category.
Should modifier 50 be used for bilateral hernias?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How are other same-session procedures paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures in the same session are paid at 50%.
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.
5,83949593,,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
5,84549606,,Repair umbilical lesion,A,,18.53,8.27,NA,8.27,,4.94,31.74,31.74,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00