49600
No office rateUmbilical repair
Both are in the umbilical-repair group. Compare the complete code-year descriptors and documented operative circumstances rather than relying on the abbreviated CMS labels.
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CMS RVU26D · Effective 2026-10-01
49605 Umbilical hernia repair Medicare reimbursement rates in Virginia
Reports operative repair of an umbilical hernia, with code selection based on the applicable CPT descriptor and the documented procedure. Compare 49605 office and facility rates across CMS payment localities in Virginia.
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 49605 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$4252.56–$4889.46
2 of 2 localities have a 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.
Hernia surgery
About 49605: Umbilical hernia operative repair
Reports operative repair of an umbilical hernia, with code selection based on the applicable CPT descriptor and the documented procedure.
This code represents an operation to repair a hernia at the umbilicus. A surgeon typically exposes the defect, returns or manages the hernia contents as indicated, and repairs the abdominal wall. The service is performed in an operative setting; the operative report should identify the umbilical site and describe the repair actually carried out.
Select this code only when the documented operation meets its full CPT descriptor; the brief CMS label alone does not establish distinctions among neighboring umbilical-repair codes. The report should support the diagnosis, site, operative work, and any descriptor-specific selection factors. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur 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 inappropriate for this code. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 49605
- 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 RVU84.91 · 63%
- Practice expense (office) RVU26.81 · 20%
- Malpractice RVU22.74 · 17%
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.
49605 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
This is a neighboring umbilical-repair code, not an interchangeable label. The applicable descriptor and operative documentation determine which code fits.
No office rate
This code belongs to the anterior abdominal hernia repair family. Use it only when its descriptor-specific criteria fit; do not select it solely because the hernia is near the umbilicus.
No office rate
This code describes recurrent anterior abdominal hernia repair when its criteria are met. Distinguish it from 49605 using the documented history and the applicable descriptors.
Compare 49605 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$4889.46
Virginia →
Office / nonfacility
Unavailable
Facility
$4252.56
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49605 billing questions
How do I distinguish 49605 from the neighboring umbilical-repair codes?
Use the complete CPT descriptor for the applicable code year and match its selection criteria to the operative documentation. The abbreviated CMS descriptor does not show those distinctions.
Can the related postoperative visits be billed separately?
The 90-day global period includes related postoperative care, as well as the day-before preoperative visit. The operative claim should reflect the repair, not routine related care during that period.
Should modifier 50 be reported for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be allowed. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The operative record should support each separately reported service.
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.
5,84149595,,Rpr aa hrn 1st > 10 rdc,A,,13.59,4.03,NA,4.03,,3.47,21.09,21.09,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84249596,,Rpr aa hrn 1st > 10 ncr/strn,A,,18.20,5.11,NA,5.11,,4.73,28.04,28.04,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84349600,,Repair umbilical lesion,A,,11.26,6.80,NA,6.80,,3.01,21.07,21.07,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84449605,,Repair umbilical lesion,A,,84.91,26.81,NA,26.81,,22.74,134.46,134.46,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84549606,,Repair umbilical lesion,A,,18.53,8.27,NA,8.27,,4.94,31.74,31.74,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84649610,,Repair umbilical lesion,A,,10.64,6.36,NA,6.36,,2.84,19.84,19.84,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,84749611,,Repair umbilical lesion,A,,9.11,6.13,NA,6.13,,2.43,17.67,17.67,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00