CPT 49000
Global 090 ActiveExploration of abdomen
CPT 49000 Billing & Documentation Guide
CPT code 49000 (Exploration of abdomen) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 12.23, a non-facility practice expense RVU of 6.58, and a malpractice RVU of 3.01, a total non-facility RVU of 21.82 and facility RVU of 21.82. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $732.26, though rates vary from $649.06 to $902.2 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 49000, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 49000 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 49000 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 49000
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 12.23 | 12.23 |
| Practice Expense RVU | 6.58 | 6.58 |
| Malpractice RVU | 3.01 | 3.01 |
| Total RVU | 21.82 | 21.82 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 49000
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $737.71 | $737.71 | $710.2 - $824.23 | 29 |
| Florida | $824.72 | $824.72 | $769.71 - $891.54 | 3 |
| Georgia | $739.07 | $739.07 | $724.37 - $753.76 | 2 |
| Illinois | $814.41 | $814.41 | $766.29 - $862.96 | 4 |
| Michigan | $756.37 | $756.37 | $722.66 - $790.08 | 2 |
| North Carolina | $677.79 | $677.79 | $677.79 - $677.79 | 1 |
| New York | $809.73 | $809.73 | $687.96 - $882.65 | 5 |
| Ohio | $710.49 | $710.49 | $710.49 - $710.49 | 1 |
| Pennsylvania | $734.92 | $734.92 | $705.26 - $764.57 | 2 |
| Texas | $720.5 | $720.5 | $701.89 - $768.34 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 49000
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 49000 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
Frequently Asked Questions, CPT 49000
What does CPT code 49000 mean? +
CPT code 49000 represents: Exploration of abdomen. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 49000? +
The 2026 Medicare national average non-facility payment for CPT 49000 is $732.26. Rates range from $649.06 to $902.2 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 49000? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 49000? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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