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CMS RVU26D · Effective 2026-10-01

49600 Umbilical repair Medicare reimbursement rates in Tennessee

Surgical repair of an umbilical hernia, reported for the specific repair circumstances defined by this code’s complete CPT descriptor and documentation. Compare 49600 office and facility rates across CMS payment localities in Tennessee.

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 49600 in Tennessee?

Tennessee 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

$636.54

1 of 1 localities have a supported rate.

Payment area: Tennessee

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.

Find 49600 in your payment locality →

Hernia surgery

About 49600: Umbilical hernia repair

Surgical repair of an umbilical hernia, reported for the specific repair circumstances defined by this code’s complete CPT descriptor and documentation.

This code represents operative repair of an umbilical hernia. The surgeon addresses the defect at the navel; the service is typically performed by a general surgeon in an operating room or another surgical setting. The operative report should identify the umbilical defect and describe the repair performed. Use the full CPT descriptor to confirm that this code’s specific criteria fit the case rather than relying on the abbreviated CMS label alone.

The code has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same 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 for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

CMS billing rules for 49600

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 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 RVU11.26 · 53%
  • Practice expense (office) RVU6.80 · 32%
  • Malpractice RVU3.01 · 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.

49600 compared with similar codes

Office rates for Tennessee, from the same CMS release.

49605

Umbilical hernia repair

Umbilical site

No office rate

Both have the same abbreviated CMS label. Select between them using each code’s complete CPT descriptor and the documented repair circumstances.

49606

Omphalocele repair

Giant, newborn

No office rate

The CMS short descriptors are identical; the full CPT descriptors determine which code matches the case.

49610

Gastroschisis repair

Newborn, primary closure

No office rate

This is another nearby umbilical repair code. Compare its complete descriptor with the operative report rather than choosing from the abbreviated labels.

Compare 49600 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

Office and facility base rates · shared scale starting at $0

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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 49600 in Tennessee.

PPRRVU2026_Oct_nonQPP.csv

5,843

Code
49600
Physician work
11.26
Practice expense
6.80
Malpractice
3.01

GPCI2026.csv

95

Locality
Tennessee
Physician work
1.000
Practice expense
0.909
Malpractice
0.537
Facility calculation for 49600 in Tennessee
ComponentRVULocality factorAdjusted
Physician work11.26× 1.00011.2600
Practice expense6.80× 0.9096.1812
Malpractice3.01× 0.5371.6164
Total RVUs19.0576
Conversion factor× 33.4009

Facility rate, Tennessee$636.54

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.
Explore RVUs, geographic factors and the full formula

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work11.261
Practice expense6.80.909
Malpractice3.010.537

(11.26 × 1 + 6.8 × 0.909 + 3.01 × 0.537) × $33.4009 = $636.54

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.

49600 billing questions

What documentation supports reporting this code?

The operative report should establish that the hernia is at the umbilicus and describe the repair. Confirm that the case meets the complete CPT descriptor’s criteria before selecting this code.

Does the code include routine postoperative care?

Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How does the multiple-procedure rule affect payment?

For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.

Can modifier 50 be reported?

No. The CMS facts specify that bilateral adjustment does not apply and modifier 50 is inappropriate for this code.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; 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.

RVUs for 49600PPRRVU2026_Oct_nonQPP.csv, line 5,843 (RVU26D)
Geographic factors for TennesseeGPCI2026.csv, line 95 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet