No office rate
Both codes are for initial hernia repair in a full-term infant younger than 6 months. Choose 49496 for an incarcerated or strangulated hernia and 49495 for a reducible one.
On this page
CMS RVU26D · Effective 2026-10-01
49496 Inguinal hernia repair Medicare reimbursement rates in Vermont
Repair of an initial incarcerated or strangulated inguinal hernia in a full-term infant younger than 6 months, with or without hydrocele treatment. Compare 49496 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 49496 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
$553.54
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 49496: Initial infant inguinal hernia repair, incarcerated
Repair of an initial incarcerated or strangulated inguinal hernia in a full-term infant younger than 6 months, with or without hydrocele treatment.
This code represents operative repair of an initial inguinal hernia in a full-term infant younger than 6 months when the hernia is incarcerated or strangulated. A pediatric or general surgeon typically performs the repair in an operating room. The code includes the repair whether or not a hydrocele is treated during the same procedure. It is not the reducible-hernia code for this infant group, nor the code for a preterm infant or an older child.
The operative report should support the infant’s age and full-term status, that the hernia is initial, and the finding of incarceration or strangulation; document the side or sides repaired. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral repair with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49496
- 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 RVU9.18 · 51%
- Practice expense (office) RVU6.21 · 35%
- Malpractice RVU2.46 · 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.
49496 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
This code is for a full-term infant younger than 6 months; 49492 is for a preterm infant with an incarcerated or strangulated hernia.
No office rate
Both address an incarcerated or strangulated initial hernia, but 49501 is for a child age 6 months to younger than 5 years.
Compare 49496 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
$553.54
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 49496 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,824
- Code
- 49496
- Physician work
- 9.18
- Practice expense
- 6.21
- Malpractice
- 2.46
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.18 | × 1.000 | 9.1800 |
| Practice expense | 6.21 | × 0.990 | 6.1479 |
| Malpractice | 2.46 | × 0.506 | 1.2448 |
| Total RVUs | 16.5727 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$553.54
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.18 | 1 |
| Practice expense | 6.21 | 0.99 |
| Malpractice | 2.46 | 0.506 |
(9.18 × 1 + 6.21 × 0.99 + 2.46 × 0.506) × $33.4009 = $553.54
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.
49496 billing questions
How do I distinguish this code from 49495?
Use 49496 when the initial hernia is incarcerated or strangulated. Code 49495 is for a reducible hernia in the same full-term infant age group.
Does the code include hydrocele treatment performed with the repair?
Yes. This repair code covers the service whether or not a hydrocele is treated during the same operation.
What documentation supports reporting 49496?
Document the infant’s age and full-term status, that this is an initial hernia, the operative finding of incarceration or strangulation, and the side repaired.
How is a bilateral repair reported?
When both sides are repaired, report modifier 50; CMS pays the bilateral procedure at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care.
Can an assistant or co-surgeon be paid?
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.
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
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
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