2025 CPT code 49505
(Active) Effective Date: N/A Revision Date: N/A Surgery - Hernia Open Procedures Surgery Feed
Repair of an initial inguinal hernia in patients 5 years or older; reducible.
Modifiers 22 (Increased Procedural Services), 50 (Bilateral Procedure), 51 (Multiple Procedures), and 52 (Reduced Services) may be applicable depending on the specifics of the procedure.
Medical necessity is established by the presence of a symptomatic reducible inguinal hernia causing discomfort or other symptoms that negatively impact the patient's daily life.The repair is considered medically necessary to alleviate these symptoms and prevent potential complications.
The surgeon is responsible for all aspects of the procedure, including pre-operative assessment, surgical repair, and post-operative care as defined by the global surgical package.
In simple words: This code covers surgery to fix a groin hernia in a child aged 5 or older. The doctor will make a small cut, fix the hernia, and sew it up. The hernia is reducible, which means it can be pushed back into place before the repair.
This CPT code describes the surgical repair of an initial (first-time) inguinal hernia in patients aged 5 years or older. The hernia is reducible, meaning the contents of the hernia can be manually pushed back into the abdominal cavity.The procedure involves an incision in the groin, exposure of the inguinal canal, identification and mobilization of the hernia sac, and closure of the internal ring and repair of the posterior inguinal canal wall.The ilioinguinal nerve and spermatic cord (if present) are handled during the procedure.
Example 1: A 6-year-old presents with a reducible right inguinal hernia. The surgeon performs an open repair., A 10-year-old presents with a reducible left inguinal hernia. The surgeon performs a bilateral repair (requires modifier 50)., An 8-year-old presents with a small reducible inguinal hernia, which is repaired with minimal dissection.Modifier 52 might apply.
A complete history and physical exam, pre-operative and post-operative diagnoses, operative report detailing the procedure and findings, and any pathology reports if applicable.
** Always refer to the most up-to-date CPT manual and payer guidelines for accurate coding and reimbursement.This information is for guidance only and should not substitute for professional medical coding advice.
- Revenue Code: P5C (Ambulatory Procedures - Inguinal Hernia Repair)
- RVU: This information is not available in the provided source.Relative Value Units (RVUs) vary based on geographic location and payer.
- Global Days : The global period for this procedure varies by payer and local guidelines. It's important to consult the specific payer's policies for details on included post-operative care.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not typically applied to this code as it's a comprehensive surgical procedure.
- Fee Schedule : Historical fee schedule data is not available in the provided sources. Fee schedules vary based on payer, geographic location, and year.
- Specialties:General Surgery, Pediatric Surgery
- Place of Service:Office, Ambulatory Surgical Center, Inpatient Hospital