CPT 49010
Global 090 ActiveExploration behind abdomen
CPT 49010 Billing & Documentation Guide
CPT code 49010 (Exploration behind abdomen) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 15.66, a non-facility practice expense RVU of 6.34, and a malpractice RVU of 3.88, a total non-facility RVU of 25.88 and facility RVU of 25.88. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $865.68, though rates vary from $765.84 to $1081.52 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 49010, 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 49010 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 49010 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 49010
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 15.66 | 15.66 |
| Practice Expense RVU | 6.34 | 6.34 |
| Malpractice RVU | 3.88 | 3.88 |
| Total RVU | 25.88 | 25.88 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 49010
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 | $862.65 | $862.65 | $833.5 - $955.42 | 29 |
| Florida | $987.8 | $987.8 | $920.28 - $1071.25 | 3 |
| Georgia | $880.93 | $880.93 | $866.43 - $895.42 | 2 |
| Illinois | $977.16 | $977.16 | $918.95 - $1036.96 | 4 |
| Michigan | $904.31 | $904.31 | $862.71 - $945.91 | 2 |
| North Carolina | $803.44 | $803.44 | $803.44 - $803.44 | 1 |
| New York | $960.29 | $960.29 | $815.34 - $1048.98 | 5 |
| Ohio | $847.03 | $847.03 | $847.03 - $847.03 | 1 |
| Pennsylvania | $873.72 | $873.72 | $839.92 - $907.52 | 2 |
| Texas | $854.79 | $854.79 | $836.16 - $915.85 | 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 49010
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 49010 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 |
| 0888T | Column 1 (primary), can be billed with modifier | No | CPT Separate procedure definition |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
Frequently Asked Questions, CPT 49010
What does CPT code 49010 mean? +
CPT code 49010 represents: Exploration behind abdomen. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 49010? +
The 2026 Medicare national average non-facility payment for CPT 49010 is $865.68. Rates range from $765.84 to $1081.52 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 49010? +
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 49010? +
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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