Summary & Overview
CPT 49500: Pediatric Inguinal Hernia Repair, Reducible
CPT code 49500 designates repair of an initial, reducible inguinal hernia in young children (six months to five years), with optional excision of a coincident hydrocele. This pediatric surgical code is commonly used for elective operative management of groin hernias and associated scrotal swelling and is relevant to hospital and ambulatory surgery centers nationwide. Coverage, coding accuracy, and appropriate site-of-service designation affect utilization, claim adjudication, and payment across public and commercial payers.
Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common modifiers and claims considerations (listed separately), and guidance on where to locate applicable payer policies. The publication highlights benchmarks and policy updates that influence authorization and bundling, billing nuances for pediatric hernia versus adult variants, and coding pitfalls that can lead to claim denials.
This resource is intended for coding professionals, revenue cycle leaders, and clinicians who need a national-level overview of CPT code 49500, its clinical scope, and the payer landscape relevant to pediatric inguinal hernia repair.
Billing Code Overview
CPT code 49500 describes repair of an initial, reducible inguinal hernia in a child aged six months to five years. The procedure may include excision of an associated hydrocele in the scrotum when present.
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Service type: Pediatric surgical hernia repair (inguinal), may include hydrocelectomy
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Typical site of service: Ambulatory surgical center or hospital operating room for pediatric surgical procedures
Clinical & Coding Specifications
Clinical Context
A 2-year-old male presents to pediatric surgery with a palpable, reducible right inguinal bulge noted by the parents and intermittent scrotal swelling examined in clinic. The child is otherwise healthy with no prior abdominal surgery. The surgeon schedules an elective repair of a reducible indirect inguinal hernia under general anesthesia, likely performed in an ambulatory surgical center or hospital outpatient department. Typical workflow: history and focused exam in clinic; preoperative assessment and anesthesia evaluation; same-day admission to ambulatory surgery or pediatric operating room; general endotracheal anesthesia or laryngeal mask airway; inguinal incision, high ligation of sac ± excision of associated hydrocele; hemostasis and layered closure; post-anesthesia recovery and discharge with pediatric postoperative instructions to the caregiver. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for qualifying beneficiaries.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no other modifier applies |
22 | Increased procedural services |