Billing code 49595: Abdominal hernia repairMedicare rate & RVUs in Oregon
Repair of an initial, reducible anterior abdominal wall hernia with total defect length over 10 cm, regardless of open, laparoscopic, or robotic approach.
CMS doesn’t publish an office rate for 49595 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 49595 covers
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.
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 49595 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $696.96 |
| Rest Of Oregon | Unavailable | $669.46 |
How the 49595 rate is calculated
Each of 49595’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 · 49595
RVUs × geographic indexes × conversion factor
Work13.59
13.59 RVUs× 1.000 GPCI
Practice expense4.03
4.03 RVUs× 1.000 GPCI
Malpractice3.47
3.47 RVUs× 1.000 GPCI
Adjusted RVUs
21.0900
Conversion factor
$33.4009
Medicare rate
$704.42
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49595
The CMS indicators that decide how 49595 is paid alongside other services.
CMS payment indicators · 49595
Abdominal hernia repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49595 without 51 · national facility
$704.42
Abdominal hernia repair
49595-51 · Second procedure: 50%
$352.21
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%).
49595 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49593Abdominal hernia repair
- 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.
- 49594Hernia repair
- 49594 covers a nonreducible or strangulated initial hernia measuring 3 cm through 10 cm. 49595 is reducible and over 10 cm.
- 49596Abdominal hernia repair
- Both apply to an initial repair over 10 cm. Use 49595 when the hernia is reducible and 49596 when it is nonreducible or strangulated.
- 49617Abdominal hernia repair
- 49617 is for a recurrent reducible anterior abdominal hernia over 10 cm; 49595 is for an initial repair with the same size and reducibility.
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 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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