Summary & Overview
CPT 49615: Recurrent Anterior Abdominal Hernia Repair, 3–10 cm
CPT code 49615 represents recurrent repair of one or more anterior abdominal hernias with a total defect length of 3 cm to 10 cm. This procedure can be performed via any surgical approach and may include implantation of mesh or another prosthesis. The code is important nationally because hernia recurrence and repairs are common surgical events with implications for surgical practice patterns, facility utilization, and payer reimbursement across inpatient and outpatient surgical settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise clinical and billing context for CPT code 49615, and outlines typical sites of service: hospital operating rooms and ambulatory surgical centers.
Readers will learn the clinical scope of the code, typical service settings, and which major payers commonly cover similar procedures. Where available, the publication summarizes benchmark considerations, common billing modifiers, and related coding practices. Data not available in the input is identified explicitly, and the content focuses on national implications rather than state-specific policy.
Billing Code Overview
CPT code 49615 describes a surgical procedure for recurrent repair of one or more anterior abdominal hernias with a combined defect length of 3 cm to 10 cm. The hernias are reducible, and the surgeon may use any approach to perform the repair. Mesh or another prosthesis may be implanted during the procedure.
Service Type: Surgical repair of recurrent anterior abdominal hernia (open or minimally invasive repair as indicated by the provider)
Typical Site of Service: Hospital operating room or ambulatory surgical center, depending on clinical factors and facility capabilities.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with a history of a prior open anterior abdominal wall hernia repair presents with a symptomatic, reducible recurrent incisional/ventral hernia measuring approximately 5 cm in greatest dimension. The patient reports intermittent aching and bulging at the prior incision site, worse with Valsalva and activity. Preoperative evaluation includes history and physical, review of prior operative records, targeted imaging (abdominal ultrasound or CT abdomen/pelvis when indicated) to confirm defect size and contents, and anesthesia clearance.
The surgical workflow begins with informed consent and marking of the defect. In the operating room under general anesthesia, the surgeon uses an open or laparoscopic approach based on prior repairs and anatomy. The recurrent fascial defect (total length between 3 cm and 10 cm) is identified, adhesiolysis performed if necessary, and the hernia contents reduced. The provider may perform primary fascial repair, component separation, or placement of prosthetic mesh (onlay, sublay/retromuscular, intraperitoneal) as appropriate. Hemostasis and wound closure follow standard technique. Postoperative care includes recovery room monitoring, pain control, early ambulation, wound surveillance, and instructions for activity restriction. Typical sites of service are hospital outpatient department or ambulatory surgery center. Service type: recurrent anterior abdominal wall hernia repair with or without mesh, operative surgical procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |