What this is, in plain language
Surgery to push a groin hernia back into place and reinforce the weakened abdominal wall, usually with mesh, through an open incision.
Why a clinician orders it
A groin bulge causing pain or discomfort, or a hernia at risk of becoming trapped (incarcerated).
Medical necessity — what insurers usually look at
Covered when the hernia is symptomatic. Some plans allow watchful waiting for painless hernias. Prior authorization is commonly required for planned surgery.
New to this? Read what medical necessity means and how to appeal a denial.
Documentation to ask about
- ✓Symptoms and exam findings
- ✓Prior auth approval in writing
- ✓In-network facility and surgeon
Questions for your provider
- ?Has prior auth been approved in writing?
- ?Will mesh be used, and is it covered?
Why this code is in our seed set
One of the most common general surgeries nationally; in the CMS Top 200 Ranked by Services.
Validated against
- •CMS Top 200 Level I CPT Codes Ranked by Services
- •International guidelines for groin hernia management
- •AMA CPT code 49505 descriptor
Terms you'll see
Prior AuthorizationRead more →
Some services may need plan approval before they are performed.
Medical NecessityRead more →
The insurer is reviewing whether the service is clinically appropriate for your situation.
Important: AuraCode is an educational tool. It does not provide medical, legal, or insurance advice, claims decisions, or approval guarantees. Final coverage depends on your specific plan, eligibility, diagnosis, submitted documentation, and your insurer's review.