2025 CPT code 49501
(Active) Effective Date: N/A Revision Date: N/A Surgery - Hernia repair Surgery Feed
Repair of an initial incarcerated or strangulated inguinal hernia in children aged 6 months to less than 5 years, with or without hydrocelectomy.
Modifier 50 (Bilateral Procedure) may be applicable if bilateral inguinal hernia repair is performed. Other modifiers may be necessary to accurately reflect the circumstances of the procedure.
Medical necessity is established by the presence of an incarcerated or strangulated inguinal hernia causing symptoms and requiring surgical intervention. Documentation should support the clinical indication for surgery.
The surgeon is responsible for the pre-operative assessment, the surgical procedure (including incision, exposure, dissection, reduction, and repair of the hernia defect, and hydrocelectomy if needed), and post-operative care. Anesthesia may be provided by a separate provider.
- Surgery
- Hernia repair codes; specifically inguinal hernia repair in children aged 6 months to under 5 years.
In simple words: This code describes a surgery to fix a hernia in the groin of a child between six months and five years old.A hernia is when part of the intestine bulges through a weak spot in the abdominal wall.If the hernia is trapped (incarcerated) or the blood supply is cut off (strangulated), surgery is needed to correct it. The surgery might also remove excess fluid from the scrotum if necessary.
This CPT code, 49501, reports the surgical repair of an initial inguinal hernia that is incarcerated or strangulated in a child between six months and five years of age.The procedure may include hydrocelectomy if a hydrocele is present. The surgeon will make an incision to expose the inguinal canal and hernia sac, dissect any scar tissue, remove the contents of the hernia sac, reduce the hernia, and repair the defect using absorbable sutures.If a hydrocele is present, it will be incised and the fluid removed.
Example 1: A 1-year-old male presents with an incarcerated right inguinal hernia. The surgeon performs an open repair, 49501, including hydrocelectomy., A 3-year-old female presents with a strangulated left inguinal hernia. The surgeon performs an open repair, 49501. , A 4-year-old male is diagnosed with an incarcerated right inguinal hernia with a hydrocele. The surgeon performs an open repair, 49501, including hydrocelectomy.
Pre-operative diagnosis (including imaging if performed), operative report detailing the procedure performed (including the presence and management of a hydrocele), post-operative progress notes, and any complications encountered.
** This code is specific to children aged 6 months to under 5 years.Always confirm the age of the patient before using this code.Ensure proper documentation to support medical necessity and justify the procedure.Appropriate coding for any additional procedures (e.g., hydrocelectomy) must be included.
- Revenue Code: P5E (Ambulatory Procedures - Other)
- RVU: The RVUs for this code vary by year and payer. Consult the relevant fee schedule for current values. In 2017, the Medicare RVUs were 9.36 work RVUs and 17.51 total RVUs.
- Global Days: The global period is not explicitly defined for this code but is likely to be consistent with other similar hernia repair procedures.
- Payment Status: Active
- Modifier TC rule: No TC modifier is applicable to this code, as it represents the complete surgical repair.
- Fee Schedule: Fee schedules vary by payer and year. The 2017 Medicare Relative Value Units (RVUs) were 9.36 work RVUs and 17.51 total RVUs. Refer to historical fee schedules for past values.
- Specialties:General Surgery, Pediatric Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center