No office rate
Both are for recurrent defects over 10 cm. 49617 applies when the hernia is reducible; 49618 applies when it is incarcerated or strangulated.
On this page
CMS RVU26D · Effective 2026-10-01
49618 Abdominal hernia repair Medicare reimbursement rates in Pennsylvania
Repair a recurrent anterior abdominal hernia with a total defect length over 10 cm when the hernia is incarcerated or strangulated. Compare 49618 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 49618 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
$1104.49–$1189.93
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 49618: Recurrent large incarcerated abdominal hernia repair
Repair a recurrent anterior abdominal hernia with a total defect length over 10 cm when the hernia is incarcerated or strangulated.
This code represents operative repair of a recurrent anterior abdominal wall hernia when the total length of the defect or defects is greater than 10 cm and the hernia is incarcerated or strangulated. General and acute care surgeons commonly perform the repair in a hospital operating room, using an open, laparoscopic, or robotic approach. Mesh or another prosthesis may be implanted as part of the repair.
Choose the code from the operative findings: the hernia must be recurrent, the total defect length must exceed 10 cm, and the hernia must be incarcerated or strangulated. Documentation should establish the prior repair, defect measurement, and clinical status, along with the repair performed. Mesh placement is included in the hernia repair. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is 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 50% reduction. Modifier 50 is inappropriate; assistant-at-surgery payment may be made, co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49618
- 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 RVU22.10 · 65%
- Practice expense (office) RVU6.09 · 18%
- Malpractice RVU5.69 · 17%
3K
Medicare services in 2024 · #2181 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.
49618 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
Both describe recurrent incarcerated or strangulated hernias, but 49616 is for a total defect length of 3 to 10 cm; 49618 is for over 10 cm.
No office rate
This code is for an initial anterior abdominal hernia over 10 cm that is incarcerated or strangulated. Use 49618 when the hernia is recurrent.
Compare 49618 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
$1189.93
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$1104.49
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49618 billing questions
How does this code differ from 49617?
Both describe repair of a recurrent anterior abdominal hernia with a total defect length over 10 cm. Use 49618 when the hernia is incarcerated or strangulated; 49617 is for a reducible hernia.
Is mesh separately reportable with this repair?
Mesh or another prosthesis placed as part of the hernia repair is included in the code. The repair should not be split into separate hernia-repair and mesh-placement charges.
What documentation supports the size level?
Document the total length of the defect or defects and the operative findings supporting that the hernia is recurrent and incarcerated or strangulated.
Should modifier 50 be appended for more than one defect?
No. CMS identifies modifier 50 as inappropriate for this code; multiple defects are considered in the total defect length used to select the code.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. The code has a 0-day global period, which includes same-day preoperative and postoperative care.
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.
5,85049615,,Rpr aa hrn rcr 3-10 rdc,A,,11.17,3.40,NA,3.40,,2.91,17.48,17.48,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85149616,,Rpr aa hrn rcr 3-10 ncr/strn,A,,15.16,4.34,NA,4.34,,3.95,23.45,23.45,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85249617,,Rpr aa hrn rcr > 10 rdc,A,,15.63,4.57,NA,4.57,,4.00,24.20,24.20,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85349618,,Rpr aa hrn rcr > 10 ncr/strn,A,,22.10,6.09,NA,6.09,,5.69,33.88,33.88,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85449621,,Rpr parastomal hernia rdc,A,,13.36,3.94,NA,3.94,,3.16,20.46,20.46,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85549622,,Rpr parastomal hrna ncr/strn,A,,16.63,4.71,NA,4.71,,4.10,25.44,25.44,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85649623,,Rmvl ninfct mesh hernia rpr,A,,3.66,0.90,NA,0.90,,0.95,5.51,5.51,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00