Billing code 49187: Open lesion surgeryMedicare rate & RVUs in Washington
Open surgery to excise or destroy an intra-abdominal tumor, cyst, or endometrioma measuring 5.1–10 cm.
CMS doesn’t publish an office rate for 49187 in Washington.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 49187 covers
This code describes open surgical excision or destruction of an intra-abdominal tumor, cyst, or endometrioma in the 5.1–10 cm size band. General surgeons, gynecologic surgeons, or surgical oncologists may perform the service when treating a lesion that requires open access. The code distinguishes this work by the lesion’s size as well as the open approach and treatment performed.
Select the size-level code supported by the documented lesion measurement. The operative report should identify the target and location, the open approach, whether the lesion was excised or destroyed, and its size. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
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.
Where 49187 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,528.49 |
| Seattle (King Cnty) | Unavailable | $1,644.47 |
How the 49187 rate is calculated
Each of 49187’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 49187
RVUs × geographic indexes × conversion factor
Work27.93
27.93 RVUs× 1.000 GPCI
Practice expense11.95
11.95 RVUs× 1.000 GPCI
Malpractice6.42
6.42 RVUs× 1.000 GPCI
Adjusted RVUs
46.3000
Conversion factor
$33.4009
Medicare rate
$1,546.46
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49187
49187 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49187
Open lesion surgery
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49187
Open lesion surgery
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49187 without 51 · national facility
$1,546.46
Open lesion surgery
49187-51 · Second procedure: 50%
$773.23
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
49187 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49186Open lesion removal
- This sibling is for the smaller lesion size band. Use 49187 for a lesion measuring 5.1–10 cm.
- 49188Open lesion treatment
- This sibling is for the next larger lesion size band. Use 49187 when the documented measurement falls within 5.1–10 cm.
- 49180Mass biopsy
- 49180 is for biopsy of an abdominal mass; 49187 describes open excision or destruction of a lesion in the specified size band.
- 49185Fluid collection treatment
- 49185 describes sclerotherapy of a fluid collection, rather than open excision or destruction of an intra-abdominal tumor, cyst, or endometrioma.
49187 billing questions
How does 49187 differ from 49186 or 49188?
These are size-level siblings for open treatment of intra-abdominal lesions. Use 49187 when the documented lesion measures 5.1–10 cm; 49186 is the smaller size band and 49188 the next larger band.
Is this code for biopsy of an abdominal mass?
No. 49187 describes open excision or destruction of a lesion in its specified size band. 49180 is the nearby code for biopsy of an abdominal mass.
What operative documentation supports 49187?
Document the lesion’s location and size, the open approach, and whether it was excised or destroyed. The recorded measurement should support the 5.1–10 cm band.
How does the 90-day global period affect billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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