No office rate
49188 is for an open-treated intra-abdominal lesion measuring 10.1-20 cm; this code is for the next size band, 20.1-30 cm.
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CMS RVU26D · Effective 2026-10-01
49189 Open lesion excision Medicare reimbursement rates in Texas
Open abdominal excision or destruction of a 20.1-30 cm intra-abdominal tumor, cyst, or endometrioma is reported when operative treatment targets a lesion in this size band. Compare 49189 office and facility rates across CMS payment localities in Texas.
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 49189 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
No 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.
Where 49189 pays more and less in Texas
Abdominal surgery
About 49189: Open intra-abdominal lesion excision, 20.1-30 cm
Open abdominal excision or destruction of a 20.1-30 cm intra-abdominal tumor, cyst, or endometrioma is reported when operative treatment targets a lesion in this size band.
This code describes open operative treatment by excision or destruction of a large intra-abdominal tumor, cyst, or endometrioma in the 20.1-30 cm size band. General surgeons, gynecologic surgeons, and surgical oncologists may perform the service in a hospital operating room. The operative report should establish the open approach, the lesion treated, the method of treatment, and its documented size.
Choose this level based on the treated lesion’s size; use a neighboring code when it falls in another size band. The 90-day global period 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 not appropriate 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 49189
- 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 RVU39.00 · 61%
- Practice expense (office) RVU16.29 · 25%
- Malpractice RVU9.00 · 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.
49189 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
49190 applies when the lesion is larger than 30 cm. Use this code for the 20.1-30 cm band.
$160.21–$176.03
49180 is for biopsy of an abdominal mass. This code describes open excision or destruction, not tissue sampling alone.
$1,104.94–$1,270.41
49185 describes sclerotherapy of a fluid collection. This code describes open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma.
Compare 49189 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office Unavailable | Facility $2147.24 |
| Beaumont | Office Unavailable | Facility $2077.03 |
| Brazoria | Office Unavailable | Facility $2086.73 |
| Dallas | Office Unavailable | Facility $2114.20 |
| Fort Worth | Office Unavailable | Facility $2112.67 |
| Galveston | Office Unavailable | Facility $2102.25 |
| Houston | Office Unavailable | Facility $2266.98 |
| Rest Of Texas | Office Unavailable | Facility $2090.44 |
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49189 billing questions
How is this code distinguished from 49188 or 49190?
Use this code when the treated lesion measures 20.1-30 cm. Code 49188 covers the smaller 10.1-20 cm band, while 49190 is for lesions larger than 30 cm.
Can 49180 be reported for the same lesion?
49180 describes biopsy of an abdominal mass, while this code describes open excision or destruction. Report both only when the record supports distinct services rather than treating the same operative work as both sampling and definitive treatment.
Should modifier 50 be appended for bilateral disease?
No. The code’s descriptor and anatomy do not support modifier 50.
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.
What documentation supports the size-level selection?
Document the open approach, the tumor, cyst, or endometrioma treated, the treatment performed, and the lesion’s size supporting the 20.1-30 cm band.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related 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.
5,77549186,,Opn exc/dstr ntra-abd 5 cm/<,A,,21.45,10.28,NA,10.28,,4.84,36.57,36.57,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77649187,,Opn exc/dstr ntra-abd 5.1-10,A,,27.93,11.95,NA,11.95,,6.42,46.30,46.30,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77749188,,Opn exc/dst ntra-abd 10.1-20,A,,33.15,14.67,NA,14.67,,7.64,55.46,55.46,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77849189,,Opn exc/dst ntra-abd 20.1-30,A,,39.00,16.29,NA,16.29,,9.00,64.29,64.29,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77949190,,Opn exc/dstr ntra-abd >30 cm,A,,48.75,19.26,NA,19.26,,11.04,79.05,79.05,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,78049215,,Excise sacral spine tumor,A,,36.86,15.04,NA,15.04,,8.08,59.98,59.98,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,78149250,,Excision of umbilicus,A,,8.78,6.13,NA,6.13,,2.10,17.01,17.01,0,090,0.09,0.81,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00