Billing code 49606: Omphalocele repairMedicare rate & RVUs in Oregon
Reports surgical repair of a giant omphalocele in a newborn, a congenital abdominal wall defect requiring operative closure.
CMS doesn’t publish an office rate for 49606 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 49606 covers
This code identifies operative repair of a giant omphalocele in a newborn. An omphalocele is a congenital abdominal wall defect in which abdominal contents protrude through the umbilical area within a sac. Pediatric or neonatal surgeons perform the repair, typically in an operating room. The operative report should establish that the condition is an omphalocele and describe the defect and repair sufficiently to support the giant category.
Select this code by the omphalocele size category, not by treating the condition as an acquired umbilical hernia or as gastroschisis. The code has a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be made; 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 49606 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,058.47 |
| Rest Of Oregon | Unavailable | $1,010.03 |
How the 49606 rate is calculated
Each of 49606’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 · 49606
RVUs × geographic indexes × conversion factor
Work18.53
18.53 RVUs× 1.000 GPCI
Practice expense8.27
8.27 RVUs× 1.000 GPCI
Malpractice4.94
4.94 RVUs× 1.000 GPCI
Adjusted RVUs
31.7400
Conversion factor
$33.4009
Medicare rate
$1,060.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49606
49606 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49606
Omphalocele 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) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49606
Omphalocele 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
49606 without 51 · national facility
$1,060.14
Omphalocele repair
49606-51 · Second procedure: 50%
$530.07
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%).
49606 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49600Umbilical repair
- Use 49600 for a newborn omphalocele in the small size category; 49606 represents the giant category.
- 49605Umbilical hernia repair
- Use 49605 for the large omphalocele category. The documented defect category distinguishes it from the giant category reported with 49606.
- 49610Gastroschisis repair
- 49610 is for gastroschisis repair, not omphalocele repair. Base code selection on the congenital defect documented and treated.
49606 billing questions
How is 49606 distinguished from 49600 and 49605?
These codes distinguish omphalocele repairs by the size category documented for the newborn’s defect. Use 49606 for the giant category, not the small or large categories.
Is an omphalocele the same as gastroschisis for coding?
No. An omphalocele and gastroschisis are distinct congenital abdominal wall defects; this code is for giant omphalocele repair.
Does the 90-day global period include related postoperative care?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can modifier 50 be reported for a bilateral repair?
No. Bilateral adjustment is not appropriate for this code.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure 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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