No office rate
Both describe open excision or destruction of intra-abdominal tumors, cysts, or endometriomas. Use 49187 when the largest tumor is 5.1–10 cm.
On this page
CMS RVU26D · Effective 2026-10-01
49186 Open lesion removal Medicare reimbursement rates in Vermont
Reports open removal or destruction of intra-abdominal tumors, cysts, or endometriomas when the largest treated tumor measures 5 cm or less. Compare 49186 office and facility rates across CMS payment localities in Vermont.
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 49186 in Vermont?
Vermont 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
$1138.18
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Abdominal surgery
About 49186: Open excision or destruction of intra-abdominal lesions
Reports open removal or destruction of intra-abdominal tumors, cysts, or endometriomas when the largest treated tumor measures 5 cm or less.
The surgeon uses an open abdominal approach to remove or destroy one or more intra-abdominal tumors, cysts, or endometriomas when the largest treated tumor measures 5 cm or less. General surgeons, gynecologic surgeons, and surgical oncologists may perform this service during an operation for a known lesion or disease requiring surgical treatment. Select the size level by the largest tumor, not by adding the diameters of multiple lesions.
The operative report should identify the lesion or lesions, the largest tumor's dimensions, the open approach, and whether the surgeon excised or destroyed the target. CMS assigns a 90-day major-surgery global: the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this descriptor and anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49186
- 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 RVU21.45 · 59%
- Practice expense (office) RVU10.28 · 28%
- Malpractice RVU4.84 · 13%
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.
49186 compared with similar codes
Office rates for Vermont, from the same CMS release.
$166.30
49180 is percutaneous needle biopsy for tissue sampling; 49186 is open surgical removal or destruction.
$1,190.29
49185 is sclerotherapy for a fluid collection. It is not open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma.
Compare 49186 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
Vermont →
Office / nonfacility
Unavailable
Facility
$1138.18
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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 49186 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,775
- Code
- 49186
- Physician work
- 21.45
- Practice expense
- 10.28
- Malpractice
- 4.84
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.45 | × 1.000 | 21.4500 |
| Practice expense | 10.28 | × 0.990 | 10.1772 |
| Malpractice | 4.84 | × 0.506 | 2.4490 |
| Total RVUs | 34.0762 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$1138.18
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.45 | 1 |
| Practice expense | 10.28 | 0.99 |
| Malpractice | 4.84 | 0.506 |
(21.45 × 1 + 10.28 × 0.99 + 4.84 × 0.506) × $33.4009 = $1138.18
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.
49186 billing questions
How is the size level selected when multiple lesions are treated?
Use the largest tumor's measurement; do not total the diameters of separate lesions. The operative report should document that measurement.
When would 49180 be reported instead?
49180 describes percutaneous needle biopsy of an abdominal or retroperitoneal mass. This code describes open excision or destruction, rather than needle sampling.
Can this code be reported for more than one lesion?
Yes. The code covers one or more treated lesions, with the size level determined by the largest tumor.
How does the 90-day global affect related postoperative care?
The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period.
Can an assistant or co-surgeon be billed?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team-surgery billing is not permitted.
Should modifier 50 be used for lesions on both sides?
No. Modifier 50 is inappropriate for this descriptor and anatomy.
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.
5,77249084,,Peritoneal lavage,A,,1.95,0.46,NA,0.46,,0.46,2.87,2.87,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77349180,,Biopsy abdominal mass,A,,1.69,3.23,,0.26,,0.18,5.10,2.13,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,77449185,,Sclerotx fluid collection,A,,2.29,33.53,,0.56,,0.30,36.12,3.15,0,000,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817