Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated

CPT 49507 is the billing code for "Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated". For urgent repair of incarcerated or strangulated inguinal hernia requiring immediate intervention

Medicare pays approximately $578.68 for CPT 49507 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 49507 has a total RVU of 28.28, broken down as: Work RVU 12.80, Practice Expense RVU 14.20, and Malpractice RVU 1.28. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 49507 include: Evidence of incarceration or strangulation; Viability of incarcerated contents; Any bowel resection required; Technique for reduction and repair. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 49507: Includes hernia repair. Includes reduction of incarcerated contents Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 49507 include: 22 (Increased procedural services for extensive tissue damage), 51 (Multiple procedures performed same session), 59 (Distinct procedural service if bowel resection performed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 49507 is 60-90 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.