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2025 CPT code 49495

Repair of an initial, reducible inguinal hernia in a full-term infant under 6 months or a preterm infant over 50 weeks post-conception and under 6 months, with or without hydrocelectomy.

Follow the official CPT coding guidelines for hernia repair procedures, paying particular attention to the distinctions between initial versus recurrent hernia repairs, and reducible versus incarcerated or strangulated hernias.

Modifiers may apply depending on the circumstances of the procedure.Modifier 50 (Bilateral Procedure) is appropriate for bilateral repairs.Other modifiers may be necessary based on the individual case.

Surgical repair is medically necessary to prevent complications associated with incarcerated or strangulated hernias, such as bowel obstruction or necrosis.In reducible hernias, repair is considered medically necessary to prevent future complications or recurrence.

The surgeon's responsibility includes pre-operative assessment, surgical repair of the hernia (and hydrocelectomy if indicated), and post-operative care.Anesthesia may be provided by the surgeon or an anesthesiologist.

IMPORTANT:For incarcerated or strangulated hernias in this age group, use CPT code 49496. For preterm infants up to 50 weeks post-conception, use CPT code 49491. For sliding inguinal hernias of any age, use CPT code 49525.

In simple words: This code covers surgery to fix a groin hernia in a baby younger than six months old.The hernia must be able to be pushed back in easily.If the baby also has a fluid-filled sac in the scrotum (hydrocele), that may be removed during the surgery.

This CPT code, 49495, encompasses the surgical repair of an initial, reducible inguinal hernia in an infant less than six months of age.The infant may be full-term or preterm, but if preterm, must be over 50 weeks post-conception. The procedure includes the repair of the hernia defect and may also involve hydrocelectomy (excision of a hydrocele) if present.The repair is performed using a technique appropriate for pediatric patients.

Example 1: A full-term infant presents with a reducible right inguinal hernia at 2 months of age. The surgeon performs an open repair of the hernia. CPT code 49495 is reported., A preterm infant (34 weeks gestation) at 52 weeks post-conception age presents with a reducible left inguinal hernia.The surgeon repairs the hernia and removes a small hydrocele. CPT code 49495 is reported., A 5-month-old infant presents with a reducible bilateral inguinal hernia.The surgeon performs a bilateral repair. CPT code 49495 is reported with modifier 50 (Bilateral Procedure).

Complete medical history, physical examination documenting the hernia, operative report detailing the surgical technique, post-operative assessment, and any relevant imaging studies (if performed).

** Accurate coding requires precise documentation that specifies the type of hernia (inguinal), its reducibility, and the patient's age and gestational status.Always refer to the most current CPT manual and payer guidelines for accurate coding and reimbursement.

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