CPT 49521
Global 090 ActiveRerepair ing hernia blocked
CPT 49521 Billing & Documentation Guide
CPT code 49521 (Rerepair ing hernia blocked) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 11.19, a non-facility practice expense RVU of 6.4, and a malpractice RVU of 2.92, a total non-facility RVU of 20.51 and facility RVU of 20.51. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $687.97, though rates vary from $607.61 to $842.94 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 49521, 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 49521 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 49521 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 49521
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 11.19 | 11.19 |
| Practice Expense RVU | 6.4 | 6.4 |
| Malpractice RVU | 2.92 | 2.92 |
| Total RVU | 20.51 | 20.51 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 49521
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 | $692.98 | $692.98 | $666.67 - $775.4 | 29 |
| Florida | $778.09 | $778.09 | $724.7 - $842.94 | 3 |
| Georgia | $694.95 | $694.95 | $680.69 - $709.2 | 2 |
| Illinois | $768 | $768 | $721.36 - $815.04 | 4 |
| Michigan | $711.76 | $711.76 | $679.04 - $744.48 | 2 |
| North Carolina | $635.52 | $635.52 | $635.52 - $635.52 | 1 |
| New York | $762.55 | $762.55 | $645.4 - $832.96 | 5 |
| Ohio | $667.24 | $667.24 | $667.24 - $667.24 | 1 |
| Pennsylvania | $690.77 | $690.77 | $662.16 - $719.37 | 2 |
| Texas | $676.86 | $676.86 | $658.89 - $723.22 | 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 49521
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 49521 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 49521
What does CPT code 49521 mean? +
CPT code 49521 represents: Rerepair ing hernia blocked. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 49521? +
The 2026 Medicare national average non-facility payment for CPT 49521 is $687.97. Rates range from $607.61 to $842.94 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 49521? +
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 49521? +
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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