CPT
43239 — Upper GI endoscopy with biopsy
High-volume procedure with predictable surprise-bill risk.
Surgery & procedures
49591 — Repair initial anterior abdominal hernia, reducible; defect less than 3 cm
Note: CPT 49585 (umbilical hernia repair) was deleted effective January 1, 2023.
- Typical setting: Hospital OR, ASC
- National avg charge (illustrative): $450-$900 Medicare allowed for surgeon professional fee (total facility + professional charges: $2,500-$8,000; commercial payers vary widely)
- Most-disputed reason: Billing deleted code 49585 on or after January 1, 2023 — this code no longer exists and will be denied; use the 49591-49596 family
What it means
What 49591 actually means
Note: CPT 49585 (umbilical hernia repair) was deleted effective January 1, 2023. The replacement code 49591 covers open, laparoscopic, or robotic repair of an initial reducible hernia of the anterior abdominal wall (including umbilical, epigastric, and incisional hernias) when the total defect is less than 3 cm. Mesh use is typically included in the work value. A 0-day global period applies, meaning post-op E/M visits are billed separately.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billing deleted code 49585 on or after January 1, 2023 — this code no longer exists and will be denied; use the 49591-49596 family
- Incorrect defect size: billing 49591 when the operative note documents a defect of 3 cm or more — use 49592 (3-10 cm) or 49593 (10+ cm) for larger defects
- Separate mesh billing: billing separately for mesh or prosthesis implantation using an add-on code when it is already included in 49591 unless removal of prior mesh was required (use add-on code 49623)
If you see 49591 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 49591 often also see these adjacent codes on the same bill.
CPT
43644 — Laparoscopic Roux-en-Y gastric bypass with small intestine reconstruction
Verify the code matches the actual service and dose.
CPT
45378 — Diagnostic colonoscopy
If your screening colonoscopy turned diagnostic, federal rules limit your cost-share.
CPT
45380 — Colonoscopy, flexible, with biopsy, single or multiple
Verify the code matches the actual service and dose.
Related BillBusted guides
Plain-English reads if you see 49591 on a bill.
49591 FAQ
Plain-English answers.
What does 49591 usually cost?
$450-$900 Medicare allowed for surgeon professional fee (total facility + professional charges: $2,500-$8,000; commercial payers vary widely). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on 49591?
Billing deleted code 49585 on or after January 1, 2023 — this code no longer exists and will be denied; use the 49591-49596 family
What should I do if I see 49591 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to 49591 before paying.
Don't pay 49591 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.