C7565 Rpr aa hrn < 3 rdc w/ rmvl

Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (i.e., open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s) less than 3 cm, reducible with removal of total or near total non-infected mesh or other prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair

Medically Unlikely Edits (effective October 1, 2026)

Payer policies and prior authorization for C7565

Payer coverage policies that name C7565

C7565 appears in 2 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAbdominoplasty, Suction Lipectomy, and Ventral Hernia Repair (0211)covered if criteria are metAug 18, 2026payer document
AetnaCosmetic Surgery and Procedures (0031)not coveredJun 25, 2026payer document

Medicaid fee-for-service

  • AZ: $1542.68 (asc), effective Oct 1, 2026
  • KY: $2752.24 (asc), effective Jan 1, 2026
  • MA: $2298.62 (asc), effective May 1, 2026
  • ND: $1622.44 (physician, facility), effective Aug 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.