Summary & Overview
CPT 49495: Infant Inguinal Hernia Repair, Reducible (May Include Hydrocelectomy)
CPT code 49495 describes surgical repair of an initial, reducible inguinal hernia in infants under six months of age, and may include excision of an associated hydrocele. This pediatric procedure is clinically important because early repair can prevent incarceration and potential complications, and because timing relative to prematurity (up to 50 weeks post-conception) affects eligibility for this specific code. Nationally, 49495 is relevant to pediatric surgeons, hospitals, ambulatory surgical centers, and payers that cover infant surgical services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical settings of care, plus guidance on the types of benchmarks and policy topics commonly associated with this code: utilization patterns for early-life hernia repair, payer coverage nuances for infants born premature versus full-term, site-of-service considerations (hospital OR vs outpatient surgical center), and common billing considerations for procedures that include hydrocele excision. Data not available in the input is noted where relevant. The publication aims to inform billing staff, clinical coders, and policy analysts about the scope and practical implications of CPT code 49495 in a national context.
Billing Code Overview
CPT code 49495 describes repair of an initial reducible inguinal hernia in an infant less than six months of age (including full-term infants and premature infants up to 50 weeks post-conception). The procedure may also include excision of an associated hydrocele of the scrotum when present.
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Service type: Pediatric surgical repair of an inguinal hernia, with possible hydrocelectomy
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Typical site of service: Hospital operating room or outpatient surgical center providing pediatric surgical procedures
Clinical & Coding Specifications
Clinical Context
A 3-month-old full-term male infant presents to pediatric surgery clinic with a palpable, reducible swelling in the right groin noted by the parents for several weeks. There is occasional intermittent scrotal fullness consistent with a communicating hydrocele. Examination shows a reducible inguinal hernia without erythema, systemic symptoms, or incarceration. After preoperative evaluation, the infant is scheduled for outpatient surgical repair under general anesthesia. Typical workflow: preoperative assessment and anesthesia clearance, informed consent from parent/guardian, standard pediatric anesthesia induction and monitoring in an ambulatory surgery center or pediatric OR, inguinal incision, high ligation of the patent processus vaginalis and repair of the hernia sac with excision of the hydrocele sac if present, recovery in PACU, discharge home same day with routine postoperative instructions and follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard service | Use for standard reporting when no modifier is required |
11 | Professional component | Use when reporting only the physician's professional component if applicable |