Summary & Overview
CPT 49250: Excision of Umbilicus for Hernia or Nonhealing Infection
CPT code 49250 denotes the surgical excision of the umbilicus, most often performed to address umbilical hernia or persistent infection at the navel. Nationally, this code captures definitive surgical management when conservative treatment is inadequate, and it appears on procedure claims across ambulatory surgical centers and hospital operating rooms. Coverage, coding practices, and payment levels for this procedure affect surgeons, hospitals, and payers handling hernia and soft-tissue infection care.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 49250, common settings where the procedure is billed, and which payers commonly encounter this code. The publication also summarizes benchmark considerations, typical modifier use patterns (listed separately), and policy or coverage issues pertinent to surgical repair and infection management.
This summary equips billing managers, surgical practices, and revenue cycle staff with a clear description of when CPT code 49250 applies, payers likely to adjudicate claims for the service, and the areas of coding and policy to review when preparing, submitting, or auditing claims nationally.
Billing Code Overview
CPT code 49250 describes the surgical excision of the umbilicus (navel). This procedure is performed primarily to treat an umbilical hernia or to remove a nonhealing infection centered at the umbilicus.
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Service type: Surgical excision of the umbilicus
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Typical site of service: Ambulatory surgical center or hospital operating room, depending on patient complexity and clinical setting
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old adult presenting with a symptomatic umbilical hernia or chronic nonhealing omphalitis with localized infection at the umbilicus. The patient reports pain, an intermittent bulge at the navel, and occasional skin breakdown with drainage. Preoperative evaluation includes history and physical, assessment for reducibility of the hernia, evaluation of comorbidities (e.g., obesity, diabetes), and informed consent for excision of the umbilicus with hernia repair or debridement.
The clinical workflow: preoperative evaluation and optimization (primary care or surgical clinic), preoperative anesthesia assessment if sedation or general anesthesia anticipated, intraoperative excision of the umbilicus with appropriate hemostasis and closure — often combined with repair of the hernia defect using primary suture or mesh as indicated — and postoperative wound care and follow-up. Typical sites of service are an ambulatory surgical center or hospital outpatient department; inpatient service may be used if comorbidities or concurrent procedures require admission.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Primary procedure | When 49250 is the main service performed during the encounter |