Billing code 49491: Inguinal hernia repairMedicare rate & RVUs in Oregon
Repair an initial, reducible inguinal hernia in an infant born preterm, with code selection based on prematurity and the hernia’s reducibility.
CMS doesn’t publish an office rate for 49491 in Oregon.
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 49491 covers
This code is for operative repair of an initial inguinal hernia in an infant born before 37 weeks’ gestation when the hernia is reducible. Pediatric surgeons and general surgeons commonly perform the repair in a hospital or other surgical setting. The operative report should establish that this is the initial repair, document the infant’s gestational age at birth, and describe the hernia as reducible. Record the side or sides treated and any other procedures performed during the session.
Choose this code for the preterm-infant category, not the neighboring category for a full-term infant. A 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral repair reported with modifier 50, payment is at 150%. Assistant-at-surgery services may be paid; 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.
Where 49491 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $769.93 |
| Rest Of Oregon | Unavailable | $730.55 |
How the 49491 rate is calculated
Each of 49491’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 · 49491
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.22Practice expense 7.39Malpractice 3.26
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49491
49491 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49491
Inguinal 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49491
Inguinal 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 50 · payment effect
With and without the modifier
49491 without 50 · national facility
$763.88
Inguinal hernia repair
49491-50 · Bilateral: 150%
$1,145.82
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
49491 compared with similar codes
Compare codes
49491 vs 49492 vs 49495 vs 49496 vs 49500: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49492Inguinal hernia repair
- Both are initial repairs for preterm infants; 49491 is for a reducible hernia, while 49492 is for an incarcerated or strangulated hernia.
- 49495Hernia repair
- This code is for a preterm infant. Use 49495 for an initial reducible repair in a full-term infant in the younger age category.
- 49496Inguinal hernia repair
- 49496 describes an incarcerated or strangulated hernia in a full-term infant in the younger age category; this code is for a preterm infant with a reducible hernia.
- 49500Inguinal hernia repair
- Both describe initial reducible inguinal hernia repair, but 49500 is for a different pediatric age category rather than a preterm infant.
49491 billing questions
When does a preterm infant’s repair qualify for this code?
Use it for an initial reducible inguinal hernia repair when the infant was born before 37 weeks’ gestation. Document gestational age at birth in the medical record.
How does this differ from 49492?
Both codes describe initial inguinal hernia repair in a preterm infant. Use 49491 for a reducible hernia and 49492 when the hernia is incarcerated or strangulated.
Can this code be reported for bilateral repair?
Yes. CMS pays a bilateral procedure reported with modifier 50 at 150%; document the repair on both sides.
Are routine postoperative visits separately reported during the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
May an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction when performed in the same session.
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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