No office rate
Both codes describe inguinal hernia repair in an infant younger than 6 months; 49495 is for a reducible hernia, while 49496 is for an incarcerated hernia.
On this page
CMS RVU26D · Effective 2026-10-01
49495 Hernia repair Medicare reimbursement rates in Vermont
Surgical repair of an initial, reducible inguinal hernia in an infant younger than 6 months, selected by age and hernia status. Compare 49495 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 49495 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
$371.31
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.
Pediatric surgery
About 49495: Infant reducible inguinal hernia repair
Surgical repair of an initial, reducible inguinal hernia in an infant younger than 6 months, selected by age and hernia status.
This service is the operative repair of an initial inguinal hernia in an infant younger than 6 months when the hernia is reducible. Pediatric surgeons commonly perform the procedure in a hospital operating room. The operative report should establish the patient’s age, the inguinal hernia diagnosis, its reducibility, and the repair performed.
Choose this code for the reducible infant presentation, not the code for an incarcerated hernia or the distinct premature-infant category. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. If multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. For bilateral repair, modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 49495
- 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 RVU6.05 · 51%
- Practice expense (office) RVU4.29 · 36%
- Malpractice RVU1.62 · 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.
49495 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
49491 identifies the premature-infant category. Use 49495 for the reducible infant case when the distinct premature-infant category does not apply.
No office rate
49500 is for a reducible initial inguinal hernia in a child age 6 months to younger than 5 years; 49495 is for an infant younger than 6 months.
Compare 49495 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
$371.31
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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 49495 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,823
- Code
- 49495
- Physician work
- 6.05
- Practice expense
- 4.29
- Malpractice
- 1.62
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.05 | × 1.000 | 6.0500 |
| Practice expense | 4.29 | × 0.990 | 4.2471 |
| Malpractice | 1.62 | × 0.506 | 0.8197 |
| Total RVUs | 11.1168 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$371.31
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.05 | 1 |
| Practice expense | 4.29 | 0.99 |
| Malpractice | 1.62 | 0.506 |
(6.05 × 1 + 4.29 × 0.99 + 1.62 × 0.506) × $33.4009 = $371.31
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.
49495 billing questions
How does 49495 differ from 49496?
49495 is for a reducible hernia in an infant younger than 6 months. Use 49496 when the hernia is incarcerated.
When should 49491 be considered instead?
49491 is the distinct code for a premature infant with a reducible inguinal hernia. Document the patient’s status and the facts supporting code selection.
How is a bilateral repair reported?
Report modifier 50 for a bilateral procedure; CMS pays it at 150%.
Are related postoperative visits separately reported?
Related postoperative care during the 90-day global period is included, along with the day-before preoperative visit.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with 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.
5,82049465,,Fluoro exam of g/colon tube,A,,0.60,3.23,,0.11,,0.06,3.89,0.77,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82149491,,Rpr hern preemie reduc,A,,12.22,7.39,NA,7.39,,3.26,22.87,22.87,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,82249492,,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
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