2025 CPT code 49491
(Active) Effective Date: N/A Revision Date: N/A Surgery - Hernia Open Procedures Surgery Feed
Repair of an initial inguinal hernia in a preterm infant (less than 37 weeks gestation), performed from birth to 50 weeks postconception, with or without hydrocelectomy; reducible.
Modifier -50 (bilateral procedure) should be appended if a bilateral hernia repair is performed.Other modifiers may be applicable depending on the circumstances of the procedure.
Medical necessity is established by the presence of a symptomatic or potentially problematic inguinal hernia.Documentation must support the need for surgical intervention based on clinical presentation and potential for complications.
The surgeon is responsible for all aspects of the surgical procedure, including incision, identification and reduction of the hernia sac, hydrocelectomy (if indicated), hernia repair, hemostasis, and wound closure.
In simple words: This code covers surgery to fix a groin hernia in a baby born prematurely. The surgery can happen anytime from birth until 50 weeks after conception. If there's also a fluid buildup in the scrotum (hydrocele), that's included in the surgery.
This CPT code, 49491, reports the surgical repair of an initial (first-time) inguinal hernia in a preterm infant (born before 37 weeks of gestation).The repair can be performed anytime from birth up to 50 weeks postconception. The procedure includes hydrocelectomy if performed concurrently.The hernia must be reducible (able to be pushed back into place manually).
Example 1: A 35-week gestation infant presents with a reducible right inguinal hernia at two weeks of age.The surgeon performs an open repair with successful reduction of the hernia sac and closure of the inguinal defect. No hydrocele is present., A 32-week gestation infant with a reducible left inguinal hernia and a hydrocele is repaired at 40 weeks postconception age. The surgeon performs an open repair including hydrocelectomy., A 36-week gestation infant presents with a bilateral reducible inguinal hernia at one month of age.The surgeon performs open bilateral repair (modifier -50 is appended).
Operative report detailing the surgical approach, findings (presence or absence of hydrocele), repair technique, and post-operative course.Pre-operative and post-operative physical examination notes.Relevant imaging (if obtained).
** Always verify the accuracy of coding and billing practices with your local payer policies and guidelines.This information is for guidance only.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: The RVUs for this code will vary based on geographic location, facility type (e.g., hospital outpatient, ambulatory surgical center), and other factors.Consult the appropriate fee schedule for current values.
- Global Days: The global period for this procedure would typically be determined by the payer.It's crucial to check individual payer guidelines for this information.
- Payment Status: Active
- Modifier TC rule: This procedure does not have a technical component (TC) modifier. The entire service is typically encompassed in the code.
- Fee Schedule: Historical fee schedule data is unavailable. Consult your local Medicare Administrative Contractor (MAC) or commercial payer for historical payment information.
- Specialties:Pediatric Surgery, General Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center