Summary & Overview
CPT 49613: Recurrent Anterior Abdominal Hernia Repair, <3 cm
CPT code 49613 denotes recurrent repair of one or more anterior abdominal hernias with a total length under 3 cm, performed via any surgical approach and permitting prosthetic implantation. This narrowly scoped procedural code is clinically relevant for surgeons, hospital billing departments, and payers because it differentiates small recurrent anterior hernia repairs from primary or larger defects, which can affect coding selection, claims adjudication, and utilization measurement. Key payers commonly engaged in national coverage and payment discussions for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers of this report will find a concise clinical context for CPT code 49613, plus operational benchmarks and policy considerations that influence how the code is applied in practice. The publication reviews typical service settings, common payer interactions, and coding nuances that affect claim submission and categorization. It also summarizes national-level implications for utilization tracking and payer coverage scope. Data on specific modifiers, ICD-10 pairings, and taxonomies are not included here; where such data are available they appear in the detailed sections of the full publication. This summary is intended to orient clinicians, coders, and policy analysts to the purpose and national significance of CPT code 49613.
Billing Code Overview
CPT code 49613 describes a surgical procedure for recurrent repair of one or more anterior abdominal hernias when the total defect length is less than 3 cm. The hernias covered under this code are reducible, meaning they can be pushed back into the abdominal cavity. The descriptor allows the surgeon to use any operative approach and permits implantation of mesh or other prosthetic material as part of the repair.
Service type: Surgical — Recurrent Anterior Abdominal Hernia Repair
Typical site of service: Operating room or ambulatory surgery center, reflecting a procedure-based, operative setting for hernia repair.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male patient with a history of prior open repair of a right-sided ventral (anterior abdominal) hernia presents with a small recurrent, reducible defect measuring approximately 2 cm in greatest dimension on clinical exam and confirmed by ultrasound. The patient reports intermittent bulging with strain and mild discomfort but no signs of bowel obstruction or strangulation. After preoperative evaluation and informed consent, the patient is scheduled for a recurrent anterior abdominal wall hernia repair.
The clinical workflow includes preoperative assessment (history, focused abdominal exam, surgical risk evaluation), anesthesia clearance (typically general or monitored anesthesia care), operative planning for a limited recurrent repair using any approach (open or laparoscopic) given the defect length < 3 cm, and possible placement of prosthetic mesh to reinforce the repair. Intraoperative steps include localization of the defect, reduction of contents, assessment of tissue integrity, excision of scar tissue if needed, primary fascial closure or suture repair supplemented by onlay/inlay/underlay mesh as indicated, and layered wound closure. Postoperative workflow includes PACU recovery, discharge instructions for activity restrictions and wound care, pain control, and routine follow-up to assess wound healing and recurrence surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier. | Use when no special modifier is applicable. |