No office rate
Both are initial repairs for young children. Choose 49500 when the hernia is reducible; 49501 describes an incarcerated or strangulated hernia.
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CMS RVU26D · Effective 2026-10-01
49500 Inguinal hernia repair Medicare reimbursement rates in Texas
Reports open repair of an initial, reducible inguinal hernia in a child age 5 years or younger, rather than an incarcerated or recurrent hernia. Compare 49500 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 49500 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 49500 pays more and less in Texas
Hernia surgery
About 49500: Initial reducible inguinal hernia repair, child
Reports open repair of an initial, reducible inguinal hernia in a child age 5 years or younger, rather than an incarcerated or recurrent hernia.
A surgeon repairs a first-time inguinal hernia in a child age 5 years or younger when the hernia is reducible. The operation typically involves exposing the inguinal canal, returning the hernia contents to the abdomen, and repairing the defect and hernia sac. Pediatric and general surgeons commonly perform the repair in an operating room, including for infants and young children with a groin bulge that can be reduced.
Choose this code when the record supports an initial inguinal hernia, reducibility, and the patient’s age; document the operative findings and repair performed. An incarcerated or strangulated hernia belongs to a different code, as does a repair of a recurrent hernia. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral repair with modifier 50, CMS pays at 150%. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49500
- 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 RVU5.69 · 46%
- Practice expense (office) RVU5.15 · 42%
- Malpractice RVU1.51 · 12%
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.
49500 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
Both are for initial, reducible inguinal hernias; the age group distinguishes them. Code 49500 is for children age 5 years or younger.
No office rate
Use 49500 for a first-time reducible hernia repair. Code 49520 is for a recurrent reducible inguinal hernia.
No office rate
Code 49500 describes open repair in the age-specific initial-repair family; 49650 is used when the initial inguinal hernia repair is performed laparoscopically.
Compare 49500 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 $417.11 |
| Beaumont | Office Unavailable | Facility $393.44 |
| Brazoria | Office Unavailable | Facility $401.38 |
| Dallas | Office Unavailable | Facility $406.36 |
| Fort Worth | Office Unavailable | Facility $405.30 |
| Galveston | Office Unavailable | Facility $404.14 |
| Houston | Office Unavailable | Facility $431.78 |
| Rest Of Texas | Office Unavailable | Facility $398.84 |
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49500 billing questions
How does this code differ from 49501?
Use 49500 for a reducible hernia in a child age 5 years or younger. Code 49501 is for an incarcerated or strangulated hernia in that age group.
How does this code differ from 49505?
Both describe initial, reducible inguinal hernia repair, but 49500 is for a child age 5 years or younger; 49505 is for the older age group.
Are the day-before visit and routine postoperative visits separately reported?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How should bilateral repairs be reported?
Report bilateral repair with modifier 50. CMS pays this bilateral procedure at 150%.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be available. 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.
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
5,82549500,,Rpr ing hernia init reduce,A,,5.69,5.15,NA,5.15,,1.51,12.35,12.35,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82649501,,Rpr ing hernia init blocked,A,,9.13,5.99,NA,5.99,,2.44,17.56,17.56,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82749505,,Prp i/hern init reduc >5 yr,A,,7.76,5.40,NA,5.40,,2.05,15.21,15.21,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82849507,,Prp i/hern init block >5 yr,A,,8.86,5.83,NA,5.83,,2.32,17.01,17.01,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00