2025 CPT code 49615
(Added) Effective Date: N/A Surgery - Hernioplasty, Herniorrhaphy, Herniotomy Procedures Surgical Procedures on the Digestive System Feed
Recurrent repair of one or more reducible anterior abdominal hernias (3-10cm total length), any approach (open, laparoscopic, robotic); mesh/prosthesis may be used.
Modifiers may be applicable depending on the circumstances of the procedure. Consult the most up-to-date NCCI edits for specific guidance.Modifier 50 may be used for bilateral procedures (with exceptions as noted in CPT guidelines).
Medical necessity is established by the presence of a symptomatic recurrent anterior abdominal hernia causing pain, discomfort, or bowel obstruction.Documentation should support the need for surgical intervention.
The surgeon is responsible for the pre-operative assessment, surgical procedure, including hernia reduction and repair, potential mesh implantation, and post-operative care. Anesthesiologist may be involved for anesthesia administration.
- Surgical Procedures on the Digestive System
- Surgical Procedures on the Digestive System > Surgical Procedures on the Abdomen, Peritoneum, and Omentum > Repair Procedures on the Abdomen, Peritoneum, and Omentum > Hernioplasty, Herniorrhaphy, Herniotomy Procedures > Hernia Open Procedures
In simple words: This code covers a surgical procedure to fix a recurring hernia in the abdomen. The hernia is able to be pushed back in, and the repair can be done in several ways, using small cuts or a larger one. A mesh or other support may be used to reinforce the repair.
This CPT code encompasses the recurrent repair of one or more anterior abdominal hernias (epigastric, incisional, ventral, umbilical, or spigelian) using any surgical approach (open, laparoscopic, or robotic).The hernias must be reducible, meaning they can be manually pushed back into the abdominal cavity. The total length of all defects, measured before opening, must be between 3 and 10 centimeters.The procedure may include the implantation of mesh or other prosthesis for reinforcement, but this is not a requirement for coding.
Example 1: A 60-year-old male patient presents with a recurrent reducible incisional hernia following previous abdominal surgery. The total length of the defect is 5 cm. The surgeon performs an open repair with mesh placement., A 45-year-old female patient has a recurrent reducible umbilical hernia, measuring 8cm in total length across multiple defects.A laparoscopic approach is used for repair with mesh reinforcement., A 72-year-old patient with a history of ventral hernia repair presents with a recurrence measuring 3cm. The surgeon performs a robotic-assisted repair, no mesh is required.
Operative report detailing the type(s) of hernia(s), approach used, size of defect(s) (before opening), technique of repair, use of mesh/prosthesis, and post-operative findings.Pre-operative and post-operative imaging, if applicable. Patient history and physical exam notes documenting the clinical presentation and recurrence of the hernia.Consent form.
** This code is specifically for recurrent hernias that are reducible.If the hernia is incarcerated or strangulated, a different code from the 49613-49618 series should be used.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable. This is a complete procedure code.
- Specialties:General Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)