No office rate
Both cover initial repair of a 3–10 cm defect. Choose 49594 for an incarcerated or strangulated hernia and 49593 when it is reducible.
On this page
CMS RVU26D · Effective 2026-10-01
49594 Hernia repair Medicare reimbursement rates in Rhode Island
Repair an initial anterior abdominal wall hernia with a 3–10 cm defect that is incarcerated or strangulated, including mesh placement when performed. Compare 49594 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 49594 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
$682.52
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.
Hernia repair
About 49594: Initial anterior abdominal hernia repair, incarcerated
Repair an initial anterior abdominal wall hernia with a 3–10 cm defect that is incarcerated or strangulated, including mesh placement when performed.
This code represents repair of an initial anterior abdominal wall hernia, such as a ventral, incisional, umbilical, or epigastric hernia, when the defect measures 3–10 cm and the hernia is incarcerated or strangulated. A surgeon performs the repair, commonly in a hospital or ambulatory surgery center. Mesh implantation, when performed as part of the repair, is included in the service.
Choose the code based on the documented defect length, whether the hernia is reducible or incarcerated/strangulated, and whether the repair is initial rather than recurrent. The operative report should support the site, defect measurement, and nonreducible or strangulated status. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. 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% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 49594
- 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 RVU13.12 · 64%
- Practice expense (office) RVU3.86 · 19%
- Malpractice RVU3.45 · 17%
20K
Medicare services in 2024 · #1148 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.
49594 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
This code covers an initial incarcerated or strangulated hernia with a defect smaller than 3 cm; 49594 is for a 3–10 cm defect.
No office rate
Both cover initial incarcerated or strangulated hernias, but 49596 is for a defect larger than 10 cm.
No office rate
Use 49614 for a recurrent incarcerated or strangulated anterior abdominal hernia with a 3–10 cm defect; 49594 describes an initial repair.
Compare 49594 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
$682.52
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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 49594 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
5,840
- Code
- 49594
- Physician work
- 13.12
- Practice expense
- 3.86
- Malpractice
- 3.45
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.12 | × 1.019 | 13.3693 |
| Practice expense | 3.86 | × 1.033 | 3.9874 |
| Malpractice | 3.45 | × 0.892 | 3.0774 |
| Total RVUs | 20.4341 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$682.52
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.12 | 1.019 |
| Practice expense | 3.86 | 1.033 |
| Malpractice | 3.45 | 0.892 |
(13.12 × 1.019 + 3.86 × 1.033 + 3.45 × 0.892) × $33.4009 = $682.52
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.
49594 billing questions
How does 49594 differ from 49593?
Both describe an initial anterior abdominal hernia repair for a 3–10 cm defect. Use 49594 for an incarcerated or strangulated hernia; 49593 is for a reducible hernia.
Is mesh separately reported with 49594?
Mesh implantation performed as part of the hernia repair is included in this service.
What documentation supports 49594?
The operative report should identify the hernia and its reducibility or strangulated status, document the defect measurement, and establish that the repair is initial rather than recurrent.
Does 49594 have a postoperative global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
Can modifier 50 be used for bilateral repair?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be made; 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 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.
5,83749591,,Rpr aa hrn 1st < 3 cm rdc,A,,5.81,2.15,NA,2.15,,1.49,9.45,9.45,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83849592,,Rpr aa hrn 1st < 3 ncr/strn,A,,8.25,2.67,NA,2.67,,2.16,13.08,13.08,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,83949593,,Rpr aa hrn 1st 3-10 rdc,A,,10.00,3.11,NA,3.11,,2.61,15.72,15.72,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84049594,,Rpr aa hrn 1st 3-10 ncr/strn,A,,13.12,3.86,NA,3.86,,3.45,20.43,20.43,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84149595,,Rpr aa hrn 1st > 10 rdc,A,,13.59,4.03,NA,4.03,,3.47,21.09,21.09,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84249596,,Rpr aa hrn 1st > 10 ncr/strn,A,,18.20,5.11,NA,5.11,,4.73,28.04,28.04,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84349600,,Repair umbilical lesion,A,,11.26,6.80,NA,6.80,,3.01,21.07,21.07,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,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