49520 Insurance Policy Changes

CPT 49520, in plain terms, covers A second surgical repair to fix a hernia that has come back or failed after a previous repair attempt. CPT 49520 is referenced in 3 tracked payer policy changes from Providence Health Plan and New Jersey Medicaid. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 49520 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 49520 on AAPC