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2025 CPT code 49500

Repair of initial inguinal hernia (reducible) in children aged 6 months to under 5 years, with or without hydrocelectomy.

Follow all CPT coding guidelines and adhere to payer-specific requirements.

Modifiers 22 (increased procedural services), 50 (bilateral procedure), 51 (multiple procedures), 52 (reduced services), 53 (discontinued procedure), 59 (distinct procedural service), 62 (two surgeons), and others may be applicable depending on the circumstances. Consult the CPT codebook for details.

Medical necessity is established by the presence of an symptomatic inguinal hernia causing pain or discomfort, or potential for complications.Documentation should support the clinical indication for surgery.

The surgeon is responsible for all aspects of the procedure, including incision, exposure of the inguinal canal, reduction of the hernia, repair of the hernia defect, reconstruction of the inguinal canal, and hydrocelectomy (if performed). Postoperative care may be billed separately.

IMPORTANT:For bilateral procedures, use modifier 50.For laparoscopic procedures, use codes 49650 or 49651 (depending on whether it is an initial or recurrent hernia). For recurrent inguinal hernias, use codes 49520 or 49521 (depending on whether the hernia is reducible or incarcerated/strangulated).

In simple words: This code covers the surgical fixing of a groin hernia in a child aged 6 months to 5 years.The doctor will repair the hernia and may also remove any fluid buildup in the scrotum.

This CPT code encompasses the surgical repair of an initial, reducible inguinal hernia in children between six months and five years of age.The procedure may include hydrocelectomy if a hydrocele is present. The surgeon will make an incision, expose the inguinal canal, reduce the hernia, and repair the hernia defect with absorbable sutures. Reconstruction of the inguinal canal is also included.If a hydrocele is present, it will be incised and the fluid removed.

Example 1: A 2-year-old male presents with a reducible right inguinal hernia. The surgeon performs an open repair, which includes hydrocelectomy due to a small hydrocele. Code 49500 is reported., A 4-year-old female is diagnosed with an initial, reducible left inguinal hernia. The surgeon performs an open repair without hydrocelectomy. Code 49500 is reported with modifier 50 (bilateral procedure) if a bilateral repair was performed., A 1-year-old presents with a reducible bilateral inguinal hernia.The surgeon performs an open repair of both sides. Code 49500 is reported with modifier 50.

Preoperative diagnosis, operative report detailing the procedure performed (including whether a hydrocelectomy was performed), and postoperative progress notes.

** Always ensure proper documentation to support medical necessity and code selection.Refer to the most current CPT manual and payer guidelines for accurate coding and reimbursement.

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