CPT 49505
Global 090 ActivePrp i/hern init reduc >5 yr
CPT 49505 Billing & Documentation Guide
CPT code 49505 (Prp i/hern init reduc >5 yr) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 7.76, a non-facility practice expense RVU of 5.4, and a malpractice RVU of 2.05, a total non-facility RVU of 15.21 and facility RVU of 15.21. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $511.33, though rates vary from $449.39 to $620.12 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 49505, 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 49505 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 49505 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 49505
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 7.76 | 7.76 |
| Practice Expense RVU | 5.4 | 5.4 |
| Malpractice RVU | 2.05 | 2.05 |
| Total RVU | 15.21 | 15.21 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 49505
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 | $519.03 | $519.03 | $497.98 - $584.49 | 29 |
| Florida | $573.45 | $573.45 | $534.53 - $620.12 | 3 |
| Georgia | $513.57 | $513.57 | $501.69 - $525.45 | 2 |
| Illinois | $565.23 | $565.23 | $530.89 - $599.41 | 4 |
| Michigan | $524.93 | $524.93 | $501.17 - $548.69 | 2 |
| North Carolina | $471.22 | $471.22 | $471.22 - $471.22 | 1 |
| New York | $565.79 | $565.79 | $478.67 - $617.39 | 5 |
| Ohio | $492.88 | $492.88 | $492.88 - $492.88 | 1 |
| Pennsylvania | $511.39 | $511.39 | $489.47 - $533.3 | 2 |
| Texas | $501.79 | $501.79 | $486.93 - $534.58 | 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 49505
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 49505 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 | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0437T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 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 | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 49505
What does CPT code 49505 mean? +
CPT code 49505 represents: Prp i/hern init reduc >5 yr. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 49505? +
The 2026 Medicare national average non-facility payment for CPT 49505 is $511.33. Rates range from $449.39 to $620.12 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 49505? +
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 49505? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team