No office rate
Choose 49621 for a reducible parastomal hernia. Choose 49622 when the parastomal hernia is incarcerated or strangulated.
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CMS RVU26D · Effective 2026-10-01
49621 Hernia repair Medicare reimbursement rates in Rhode Island
Repair a reducible hernia surrounding a stoma, using an open or minimally invasive approach, with mesh implantation included when performed. Compare 49621 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 49621 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
$684.80
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 49621: Reducible parastomal hernia repair
Repair a reducible hernia surrounding a stoma, using an open or minimally invasive approach, with mesh implantation included when performed.
This service repairs a hernia at the abdominal opening where a colostomy, ileostomy, or other stoma passes through the abdominal wall. The surgeon returns the hernia contents and repairs the defect; the hernia is reducible when its contents can be returned. The code covers open, laparoscopic, and robotic approaches, and includes mesh or another prosthesis when implanted. It is generally performed by a general or colorectal surgeon in an operating room.
Report this code for a reducible parastomal hernia, not a hernia at another abdominal site or an incarcerated or strangulated parastomal hernia. The operative note should identify the stoma site, describe the hernia and its reducibility, and document the repair approach and any prosthesis. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur 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-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49621
- 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 RVU13.36 · 65%
- Practice expense (office) RVU3.94 · 19%
- Malpractice RVU3.16 · 15%
1.8K
Medicare services in 2024 · #2545 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.
49621 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
49613 is for a qualifying anterior abdominal hernia under 3 cm, not a hernia around a stoma.
No office rate
49615 is for a qualifying anterior abdominal hernia 3–10 cm. A hernia at the stoma site is classified with the parastomal hernia codes instead.
Compare 49621 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
$684.80
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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 49621 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
5,854
- Code
- 49621
- Physician work
- 13.36
- Practice expense
- 3.94
- Malpractice
- 3.16
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.36 | × 1.019 | 13.6138 |
| Practice expense | 3.94 | × 1.033 | 4.0700 |
| Malpractice | 3.16 | × 0.892 | 2.8187 |
| Total RVUs | 20.5026 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$684.80
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.36 | 1.019 |
| Practice expense | 3.94 | 1.033 |
| Malpractice | 3.16 | 0.892 |
(13.36 × 1.019 + 3.94 × 1.033 + 3.16 × 0.892) × $33.4009 = $684.80
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.
49621 billing questions
How does this code differ from 49622?
49621 is for a reducible parastomal hernia. Use 49622 when the parastomal hernia is incarcerated or strangulated.
Does the code include mesh placement?
Yes. Mesh or another prosthesis is included when implanted as part of the parastomal hernia repair.
Can modifier 50 be used for a parastomal hernia?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
What should the operative note document?
Document the stoma site, the parastomal hernia and its reducibility, the repair performed, and any implanted prosthesis.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures performed in the same session are subject to the standard 50% multiple-procedure reduction.
Is assistant-at-surgery payment available?
CMS indicates that assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation.
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.
5,85149616,,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
5,85749650,,Lap ing hernia repair init,A,,6.20,4.87,NA,4.87,,1.63,12.70,12.70,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,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