49659
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- No explicit documentation requirements or required clinical documentation section stated in this policy.
- Policy text references typical diagnostic/evaluation measures (implicit documentation that may be relevant):
- "Imaging (e.g., ultrasound, x-ray) may be used along with physical exam."
- "Rest, and/or anti-inflammatory medications and/or physical therapy may be recommended."
Key Coverage Criteria
- None — surgical treatment for athletic pubalgia is considered experimental, investigational or unproven.
- No Medicare National Coverage Determination (NCD) or Local Coverage Determination (LCD) found for athletic pubalgia surgery (policy notes: 'No Determination found').
- Sports-related groin pain (athletic pubalgia / sports hernia) characterized by disabling, activity-dependent lower abdominal and groin pain not attributable to another cause
- Groin pain conditions in athletes sometimes labeled as athletic pubalgia, Gilmore groin, osteitis pubis, pubic inguinal pain syndrome, inguinal disruption, slap shot gut, sportsmen groin, footballers groin injury complex, hockey groin syndrome, athletic hernia, sports hernia, or core muscle injury
- Groin pain in athletes, particularly those participating in sports such as soccer, hockey, and football.
- Surgical repair of defects in muscles, tendons, or nerves for patients with groin pain who have failed conservative therapy and have identifiable defects.
7 Active Policies
CIGNA-0522 — Athletic Pubalgia Surgery - (0522)
BCBSIL-SUR705.036 — Surgery for Groin Pain in Athletes
BCBSMT-SUR705.036 — Surgery for Groin Pain in Athletes
BCBSNM-SUR705.036 — Surgery for Groin Pain in Athletes
BCBSOK-SUR705.036 — Surgery for Groin Pain in Athletes
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.