Inguinal Hernia Repair CPT Code (2023) | Description, Guidelines & Reimbursement

Inguinal Hernia Repair CPT Code(s) 49495-49557 may be billed for services when the physician performs initial or recurrent inguinal hernia repair of reducible, incarcerated, or strangulated on infants younger than six months or from 6 months to 5 years old or any age with or without hydrocelectomy. You can find a complete list with all the official descriptions of the CPT codes for Inguinal Hernia Repair here.

Description Of The Inguinal Hernia Repair CPT Codes

The physician performs surgery on an infant or adult to repair a groin hernia. It may comprise fluid drainage that accumulates around the hydrocele. 

The physician repairs an initial, reducible inguinal hernia in a full-term infant under six months or a preterm infant over 50 weeks post-conceptual age and under six months at the time of surgery, with or without hydrocelectomy.

The physician examines the pre-peritoneal axis to determine the hernia ring. They may apply manual pressure to the inguinal hernia outside the body while performing a reducible hernia. 

The physician may make an unsuccessful attempt due to the varying size of the hernia compared to the contents. They may incision and enlarge the hernia ring by electrocautery in a ventral direction.

The incision makes in a ventral to the medial direction for medial hernias and a ventrolateral direction for lateral hernias. The hernia reduces using pleural insufflation of carbon dioxide. 

The physician may incise or drain the hydrocele if present. Sutures apply to the defected hernia and may staple or mesh by force. 

Report different codes when the physician performs incarcerated or strangulated hernia. In this case, the physician empties the hernia sac contents, places the contents in the lower abdomen, and repairs the hernia defect by suture.

CPT 49495

Inguinal Hernia Repair CPT Code 49495 bills for service when the physician performs initial inguinal hernia repair of Infants younger than age six months or preterm infants older than 50 weeks post-conception age and fewer than six months age at the time of surgery. It may perform with or without hydrocelectomy; reducible

CPT 49496

CPT 49496 bills for service when the physician performs initial inguinal hernia repair of Infants younger than age six months or preterm infants older than 50 weeks post-conception age and fewer than six months age at the time of surgery. It may perform with or without hydrocelectomy, be incarcerated, or be strangulated.

CPT 49500

Inguinal Hernia Repair CPT Code 49500 bills for service when the physician performs initial inguinal hernia repair, age six months to fewer than five years, with or without hydrocelectomy; reducible

CPT 49501

CPT 49501 bills for service when the physician performs initial inguinal hernia repair, age six months to fewer than five years, with or without hydrocelectomy; incarcerated or strangulated

CPT 49505

Inguinal Hernia Repair CPT Code 49505 bills for service when the physician performs initial inguinal hernia repair, age five years or older; reducible.

CPT 49507

CPT 49507 bills for service when the physician performs initial inguinal hernia repair at age five years or older; incarcerated or strangulated

CPT 49520

CPT 49520 bills for service when the physician performs recurrent inguinal hernia repair at any age; reducible

CPT 49521

Inguinal Hernia Repair CPT Code 49521 bills for service when the physician performs recurrent inguinal hernia repair at any age, incarcerated or strangulated

CPT 49525

CPT 49525 bills for service when the physician performs recurrent inguinal hernia repair, sliding, any age

Reimbursement

A maximum of one unit can be a bill on the same service date of Inguinal Hernia Repair CPT Code(s) 49495-49521. In contrast, the Two units allow documentation supporting the service’s medical necessity.

The cost and RUVS of CPT 49495 are $447.63 and 12.93495 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49495 are $447.63 and 12.93495 when performed in the non-facility.

The cost and RUVS of CPT 49496 are $674.39 and 19.48757 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49496 are $674.39 and 19.4875 when performed in the non-facility.

The cost and RUVS of CPT 49500 are $459.31 and 13.27261 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49500 are $459.31 and 13.27261 when performed in the non-facility.

The cost and RUVS of Inguinal Hernia Repair CPT Code 49501 are $663.96 and 19.18630 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49501 are $663.96 and 19.18630 when performed in the non-facility.

The cost and RUVS of CPT 49505 are $573.15 and 16.56194 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49505 are $573.15 and 16.56194 when performed in the non-facility.

The cost and RUVS of CPT 49507 are $642.63 and 18.56993 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49507 are $642.63 and 18.56993 when performed in the non-facility.

The cost and RUVS of CPT 49520 are $691.44 and 19.98020 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49520 are $691.44 and 19.98020 when performed in the non-facility.

The cost and RUVS of CPT 49521 are $779.86 and 22.53517 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49521 are $779.86 and 22.53517 when performed in the non-facility.

The cost and RUVS of Inguinal Hernia Repair CPT Code 49525 are $627.51 and 18.13279 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49525 are $627.51 and 18.13279 when performed in the non-facility.

Inguinal Hernia Repair CPT Code Billing Guidelines

The Inguinal hernia repair includes Hernia repairs done on preterm infants older than 50 weeks post-conception and younger than six months.

If Abdominal wall debridement (11042, 11043) performs in conjunction with inguinal hernia repair, it is appropriate to 11042 and 11043 separately with the appropriate modifier when required.

Intra-abdominal hernia repair/reduction (44050) performs with inguinal hernia repair. It is appropriate to 44050 separately with a proper modifier when required.

Code also repairs or excision testicle(s), intestine, and ovaries when performed (44120, 54520, 58940) in combination with inguinal hernia repair, report with modifier if appropriate.

CPT code 49495-49521 has 90 days global period. If any Evaluation and management (E/M) service performs with CPT code 66984, modifier 24 will report with E/M service for an unrelated condition. 

 Suppose the E/M visit is for post-operative care of a prior surgical procedure. In that case, it is not appropriate to report the E/M code with 49495-49521 separately during the global period. While modifier 25 will be applicable with CPT code 49495-49521 if the patient sees an unrelated condition on the same procedure date.