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CPT 49505: Repair of Initial Inguinal Hernia in Child Age 5 or Older
CPT code 49505 represents surgical repair of an initial inguinal hernia in a child aged five years or older, a common pediatric general surgery procedure. This code captures operative management when the clinician reduces the hernia and performs definitive repair of the inguinal canal. Nationally, accurate coding for pediatric hernia repair affects surgical quality measurement, appropriate reimbursement, and resource planning for operating room and ambulatory surgical services.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the code, comparisons to closely related pediatric hernia codes, and coverage considerations that commonly arise with surgical hernia services for children. The content highlights typical sites of service and the procedural population (children aged five years and older), and it orients clinicians, billers, and policy analysts to where 49505 fits in surgical coding and billing workflows.
The publication also guides readers through common coding adjacencies—such as codes for younger pediatric patients or incarcerated/strangulated hernias—and clarifies when 49505 is the appropriate primary code. Data not available in the input includes payer-specific reimbursement rates and utilization benchmarks.
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Billing Code Overview
CPT code 49505 describes repair of an initial inguinal hernia in a child aged five years or older. The procedure involves reduction of the hernia (the provider pushes the hernia back into place) and surgical repair of the inguinal canal.
Service Type: Pediatric surgical hernia repair
Typical Site of Service: Operating room or ambulatory surgical center
National Reimbursement Benchmarks
Commercial averages sit well above Medicare for CPT 49505: Blue Cross Blue Shield and BUCA show mean rates of $3,059.20 and $2,080.10 respectively, compared with Medicare’s mean of $513.80. This places BUCA roughly four times Medicare’s average and Blue Cross Blue Shield about six times higher, underscoring substantial upward pressure from commercial contracts versus the Medicare baseline.
Rate dispersion (P75 minus P25) highlights where pricing is tight or wide. Blue Cross Blue Shield has the widest interquartile spread at $3,747.00 ($4,783.10 − $1,036.10), followed by UnitedHealth Group at $5,860.00? Wait—must calculate correctly: UnitedHealth Group P75 $1,150.40 minus P25 $564.40 equals $586.00. Cigna’s spread is $547.00 ($1,099.60 − $519.70), BUCA’s spread is $2,398.80 ($3,165.50 − $766.70), Aetna’s spread is $389.40 ($776.00 − $138.60), and Medicare’s spread is $41.00 ($534.00 − $493.00). Thus Blue Cross Blue Shield and BUCA show the widest dispersion, while Medicare and Aetna are the tightest.