Repair recurrent inguinal hernia, any age; reducible

CPT 49520 is the billing code for "Repair recurrent inguinal hernia, any age; reducible". For repair of recurrent inguinal hernia after previous surgical repair

Medicare pays approximately $622.67 for CPT 49520 (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 49520 has a total RVU of 25.65, broken down as: Work RVU 11.50, Practice Expense RVU 13.00, and Malpractice RVU 1.15. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 49520 include: History of previous hernia repair(s); Location of recurrence relative to previous repair; Findings at reoperation including mesh status; Technique for repair of recurrence. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 49520: Includes removal of previous mesh if required. Includes revision of previous repair Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 49520 include: 22 (Increased procedural services for complex revision), 50 (Bilateral procedure when both sides repaired), 51 (Multiple procedures performed same session). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 49520 is 60-90 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.