Billing code 49540: Hernia repairMedicare rate & RVUs in Washington
Reports operative repair of a lumbar hernia in the posterolateral abdominal wall, rather than a groin or anterior abdominal wall hernia.
CMS doesn’t publish an office rate for 49540 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 49540 covers
Code 49540 represents operative repair of a lumbar hernia, a defect in the posterolateral abdominal wall that may present as a flank bulge. A surgeon, commonly a general surgeon, performs the repair in an operating room, addressing the defect and any protruding tissue before closing or reinforcing the abdominal wall. The lumbar location distinguishes this service from groin and anterior abdominal wall hernia repairs.
Select the code based on the documented hernia site. The operative report should identify the lumbar location, side, defect, and repair performed. If both sides are repaired in the same session, modifier 50 invokes CMS bilateral payment at 150%. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. An assistant at surgery may be paid; co-surgeon payment requires 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 49540 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $637.43 |
| Seattle (King Cnty) | Unavailable | $690.87 |
How the 49540 rate is calculated
Each of 49540’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 · 49540
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.47Practice expense 6.10Malpractice 2.70
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 49540
49540 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49540
Hernia repair
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 49540
Hernia repair
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 50 · payment effect
With and without the modifier
49540 without 50 · national facility
$643.64
Hernia repair
49540-50 · Bilateral: 150%
$965.46
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
49540 compared with similar codes
Compare codes
49540 vs 49591 vs 49505 vs 49550: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 49591Hernia repair
- This code addresses an initial, reducible anterior abdominal hernia 3 cm or smaller. Code 49540 is for a hernia in the lumbar, posterolateral abdominal wall.
- 49505Inguinal hernia repair
- This code is for an initial inguinal hernia repair in a patient older than 5 years. Code 49540 applies to the lumbar abdominal wall, not the groin.
- 49550Femoral hernia repair
- This code repairs an initial femoral hernia. Choose 49540 only when the documented hernia is lumbar rather than in the femoral region.
49540 billing questions
How is 49540 distinguished from an anterior abdominal hernia repair?
Use 49540 when the documented defect is lumbar, in the posterolateral abdominal wall. An anterior abdominal wall hernia is coded from the applicable anterior hernia family instead.
Does the 90-day global include postoperative visits?
Related postoperative care during the 90 days after surgery is included, as is the day-before preoperative visit.
How is bilateral lumbar hernia repair reported?
When both sides are repaired in the same session, report modifier 50; CMS pays the bilateral procedure at 150%.
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.
What happens when another procedure is performed in the same session?
CMS pays the highest-valued procedure in full and the other procedures at 50%. The 90-day global also covers related postoperative care for this repair.
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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