No office rate
This code addresses an initial, reducible anterior abdominal hernia 3 cm or smaller. Code 49540 is for a hernia in the lumbar, posterolateral abdominal wall.
On this page
CMS RVU26D · Effective 2026-10-01
49540 Hernia repair Medicare reimbursement rates in Pennsylvania
Reports operative repair of a lumbar hernia in the posterolateral abdominal wall, rather than a groin or anterior abdominal wall hernia. Compare 49540 office and facility rates across CMS payment localities in Pennsylvania.
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 49540 in Pennsylvania?
Pennsylvania 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
$621.97–$675.69
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 surgery
About 49540: Lumbar hernia repair
Reports operative repair of a lumbar hernia in the posterolateral abdominal wall, rather than a groin or anterior abdominal wall hernia.
Code 49540 represents operative repair of a lumbar hernia, a defect in the posterolateral abdominal wall that may present as a flank bulge. A surgeon, commonly a general surgeon, performs the repair in an operating room, addressing the defect and any protruding tissue before closing or reinforcing the abdominal wall. The lumbar location distinguishes this service from groin and anterior abdominal wall hernia repairs.
Select the code based on the documented hernia site. The operative report should identify the lumbar location, side, defect, and repair performed. If both sides are repaired in the same session, modifier 50 invokes CMS bilateral payment at 150%. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures 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 49540
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are 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 procedure with modifier 50 is paid at 150%.
- 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 RVU10.47 · 54%
- Practice expense (office) RVU6.10 · 32%
- Malpractice RVU2.70 · 14%
171
Medicare services in 2024 · #4472 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.
49540 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
This code is for an initial inguinal hernia repair in a patient older than 5 years. Code 49540 applies to the lumbar abdominal wall, not the groin.
No office rate
This code repairs an initial femoral hernia. Choose 49540 only when the documented hernia is lumbar rather than in the femoral region.
Compare 49540 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
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$675.69
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$621.97
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
49540 billing questions
How is 49540 distinguished from an anterior abdominal hernia repair?
Use 49540 when the documented defect is lumbar, in the posterolateral abdominal wall. An anterior abdominal wall hernia is coded from the applicable anterior hernia family instead.
Does the 90-day global include postoperative visits?
Related postoperative care during the 90 days after surgery is included, as is the day-before preoperative visit.
How is bilateral lumbar hernia repair reported?
When both sides are repaired in the same session, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
What happens when another procedure is performed in the same session?
CMS pays the highest-valued procedure in full and the other procedures at 50%. The 90-day global also covers related postoperative care for this repair.
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.
5,82949520,,Rerepair ing hernia reduce,A,,9.74,5.91,NA,5.91,,2.56,18.21,18.21,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83049521,,Rerepair ing hernia blocked,A,,11.19,6.40,NA,6.40,,2.92,20.51,20.51,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83149525,,Repair ing hernia sliding,A,,8.71,5.61,NA,5.61,,2.28,16.60,16.60,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83249540,,Repair lumbar hernia,A,,10.47,6.10,NA,6.10,,2.70,19.27,19.27,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83349550,,Rpr rem hernia init reduce,A,,8.77,5.65,NA,5.65,,2.30,16.72,16.72,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83449553,,Rpr fem hernia init blocked,A,,9.67,6.04,NA,6.04,,2.52,18.23,18.23,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83549555,,Rerepair fem hernia reduce,A,,9.16,5.85,NA,5.85,,2.46,17.47,17.47,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00