No office rate
Both are initial repairs for preterm infants; 49491 is for a reducible hernia, while 49492 is for an incarcerated or strangulated hernia.
On this page
CMS RVU26D · Effective 2026-10-01
49491 Inguinal hernia repair Medicare reimbursement rates in Rhode Island
Repair an initial, reducible inguinal hernia in an infant born preterm, with code selection based on prematurity and the hernia’s reducibility. Compare 49491 office and facility rates across CMS payment localities in Rhode Island.
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 49491 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$768.02
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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.
Pediatric surgery
About 49491: Initial reducible inguinal hernia repair, preterm infant
Repair an initial, reducible inguinal hernia in an infant born preterm, with code selection based on prematurity and the hernia’s reducibility.
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.
CMS billing rules for 49491
- 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 RVU12.22 · 53%
- Practice expense (office) RVU7.39 · 32%
- Malpractice RVU3.26 · 14%
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.
49491 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
This code is for a preterm infant. Use 49495 for an initial reducible repair in a full-term infant in the younger age category.
No office rate
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.
No office rate
Both describe initial reducible inguinal hernia repair, but 49500 is for a different pediatric age category rather than a preterm infant.
Compare 49491 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
Unavailable
Facility
$768.02
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 49491 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
5,821
- Code
- 49491
- Physician work
- 12.22
- Practice expense
- 7.39
- Malpractice
- 3.26
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.22 | × 1.019 | 12.4522 |
| Practice expense | 7.39 | × 1.033 | 7.6339 |
| Malpractice | 3.26 | × 0.892 | 2.9079 |
| Total RVUs | 22.9940 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$768.02
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.22 | 1.019 |
| Practice expense | 7.39 | 1.033 |
| Malpractice | 3.26 | 0.892 |
(12.22 × 1.019 + 7.39 × 1.033 + 3.26 × 0.892) × $33.4009 = $768.02
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 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.
5,81849452,,Replace g-j tube perc,A,,2.79,18.69,,0.41,,0.30,21.78,3.50,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,81949460,,Fix g/colon tube w/device,A,,0.94,20.31,,0.22,,0.12,21.37,1.28,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82049465,,Fluoro exam of g/colon tube,A,,0.60,3.23,,0.11,,0.06,3.89,0.77,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82149491,,Rpr hern preemie reduc,A,,12.22,7.39,NA,7.39,,3.26,22.87,22.87,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82249492,,Rpr ing hern premie blocked,A,,15.04,8.22,NA,8.22,,4.02,27.28,27.28,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82349495,,Rpr ing hernia baby reduc,A,,6.05,4.29,NA,4.29,,1.62,11.96,11.96,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82449496,,Rpr ing hernia baby blocked,A,,9.18,6.21,NA,6.21,,2.46,17.85,17.85,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537