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    v1.0.30
    OpenPayerBilling CodesHernia Open ProceduresCPT cpt-49521-recurrent-incarcerated-strangulated-inguinal-hernia-repair
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    CPT 49521: Repair of Recurrent Incarcerated or Strangulated Inguinal Hernia

    Medicare pays $691 on average nationally for this procedure.

    CPT code 49521 describes a surgical procedure to repair a recurrent inguinal hernia that is incarcerated (trapped) or strangulated (blood supply compromised); the service is an open hernia repair performed in a surgical setting, typically in an operating room at an acute care hospital or ambulatory surgery center, and applies to patients of any age.

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old male presents to the emergency department with a 12-hour history of worsening right groin pain, nausea, and an irreducible bulge. Examination reveals a firm, tender mass in the right inguinal canal and signs of bowel obstruction. Imaging and surgical evaluation confirm a recurrent incarcerated inguinal hernia with compromised bowel perfusion. The patient is taken emergently to the operating room for open repair and possible bowel assessment. The clinical workflow includes rapid preoperative evaluation (airway, breathing, circulation), informed consent for hernia repair and possible bowel resection, general anesthesia, intraoperative reduction and exploration of the incarcerated contents, repair of the recurrent inguinal defect (often with tissue repair or prosthetic mesh depending on contamination and recurrence), assessment for bowel viability, resection and anastomosis if necrotic bowel is identified, postoperative monitoring in recovery or an inpatient surgical unit, and discharge planning with wound care and activity restrictions. Typical site of service is the hospital operating room; service type is emergent inpatient open surgical repair of a recurrent incarcerated or strangulated inguinal hernia. Patient age can be any age but scenarios commonly occur in older adults with prior groin surgery and comorbidities such as COPD, obesity, or prior hernia repairs.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49505Repair initial inguinal hernia, age 5 years or older; reduciblePerformed when the hernia is primary and reducible; contrasts with 49521 which is for recurrent incarcerated/strangulated hernia.
    49520Repair recurrent inguinal hernia; reducibleRelevant when recurrent hernia is present but not incarcerated or strangulated; 49521 is used when incarceration or strangulation is present.
    49566Laparoscopic repair of recurrent inguinal herniaAlternative approach for recurrent hernia; may be considered when contamination is not present and patient condition permits minimally invasive repair.
    44950Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)May be used when an abdominal exploration is required for strangulated bowel not reachable through the inguinal approach or when bowel resection is necessary.
    44120Enterectomy, resection of small intestine; single resection and anastomosisUsed when strangulation has caused bowel necrosis requiring resection and anastomosis during the same operative episode as 49521.

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    208600000X
    363L00000X
    163WL0100X
    332BD1200X
    3336N0007X
    2081P0010X
    2251N0400X

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

    CPT-49491-PREMATURE-INFANT-INGUINAL-HERNIA-REPAIR

    CPT 49491: Inguinal Hernia Repair in Premature Infant

    CPT-49492-PREMATURE-INFANT-INCARCERATED-INGUINAL-HERNIA-REPAIR

    CPT 49492: Incarcerated/Strangulated Groin Hernia Repair in Premature Infant

    CPT-49495-INFANT-REDUCIBLE-INGUINAL-HERNIA-REPAIR-HYDROCELECTOMY

    CPT 49495: Infant Inguinal Hernia Repair, Reducible, ± Hydrocele Excision

    CPT-49496-INFANT-INGUINAL-HERNIA-REPAIR-WITH-HYDROCELE-EXCISION

    CPT 49496: Infant Incarcerated/Strangulated Groin Hernia Repair

    CPT-49500-PEDIATRIC-INGUINAL-HERNIA-REPAIR-HYDROCELECTOMY

    CPT 49500: Pediatric Reducible Inguinal Hernia Repair

    CPT-49501-PEDIATRIC-INCARCERATED-INGUINAL-HERNIA-REPAIR

    CPT 49501: Repair of Incarcerated or Strangulated Inguinal Hernia in Child

    CPT-49505-PEDIATRIC-INGUINAL-HERNIA-REPAIR-AGE-5-AND-OLDER

    CPT 49505: Repair Initial Inguinal Hernia, Child 5 Years or Older

    CPT-49507-INCARCERATED-STRANGULATED-INGUINAL-HERNIA-REPAIR

    CPT 49507: Incarcerated or Strangulated Inguinal Hernia Repair

    CPT-49520-RECURRENT-REDUCIBLE-INGUINAL-HERNIA-REPAIR

    CPT 49520: Repair of Recurrent, Reducible Inguinal Hernia

    CPT-49525-SLIDING-INGUINAL-HERNIA-REPAIR

    CPT 49525: Repair of Sliding Inguinal Hernia

    Showing 1–10 of 35

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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