Here are the 2010 Medicare payments for 23 hernia procedures in the ASC setting.
1. CPT 49495 (Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; reducible) — $1,111.16
2. CPT 49496 (Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; incarcerated or strangulated) — $1,111.16
3. CPT 49501 (Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; incarcerated or strangulated) — $1,280.74
4. CPT 49505 (Repair initial inguinal hernia, age 5 years or older; reducible) — $1,111.16
5. CPT 49520 (Repair recurrent inguinal hernia, any age; reducible) — $1,198.46
6. CPT 49521 (Repair recurrent inguinal hernia, any age; incarcerated or strangulated) — $1,111.16
7. CPT 49540 (Repair lumbar hernia) — $1,067.15
8. CPT 49550 (Repair initial femoral hernia, any age; reducible) — $1,131.97
9. CPT 49553 (Repair initial femoral hernia, any age; incarcerated or strangulated) — $1,280.74
10. CPT 49555 (Repair recurrent femoral hernia; reducible) — $1,131.07
11. CPT 49557 (Repair recurrent femoral hernia; incarcerated or strangulated) — $1,280.74
12. CPT 49561 (Repair initial incisional or ventral hernia; incarcerated or strangulated) — $1,280.74
13. CPT 49565 (Repair recurrent incisional or ventral hernia; reducible ) — $1,111.16
14. CPT 49566 (Repair recurrent incisional or ventral hernia; incarcerated or strangulated) — $1,280.74
15. CPT 49570 (Repair epigastric hernia [eg, preperitoneal fat]; reducible [separate procedure]) — $1,111.16
16. CPT 49572 (Repair epigastric hernia [eg, preperitoneal fat]; incarcerated or strangulated) — $1,280.74
17. CPT 49580 (Repair umbilical hernia, younger than age 5 years; reducible) — $1,111.16
18. CPT 49582 (Repair umbilical hernia, younger than age 5 years; incarcerated or strangulated) — $1,280.74
19. CPT 49585 (Repair umbilical hernia, age 5 years or older; reducible) — $1,111.16
20. CPT 49587 (Repair umbilical hernia, age 5 years or older; incarcerated or strangulated) — 1,280.74
21. CPT 49590 (Repair spigelian hernia) — $1,082.46
22. CPT 49650 (Laparoscopy, surgical; repair initial inguinal hernia) — $1,557.98
23. CPT 49651 (Laparoscopy, surgical; repair recurrent inguinal hernia) — $1,645.28
Source: Federal Register, Vol. 74, No. 223 (pdf).
The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.