CPT 49904 Omental Flap Transfer Reimbursement | OpenPayer

Summary & Overview

CPT 49904: Omental Flap Transfer for Chest Reconstruction

CPT code 49904 represents the open harvest and rotational transfer of an omental flap to fill a chest defect while maintaining the flap's native blood supply. This reconstructive procedure is used in complex chest surgeries, including management of nonhealing wounds and chest wall defects that require well-vascularized tissue for coverage and healing. Nationally, the code is relevant to surgical departments, plastic and reconstructive surgeons, and hospital reimbursement workflows for operative chest reconstruction.

Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context, common sites of service, and the service type associated with the code. The publication summarizes typical billing considerations and common modifiers used with surgical procedures, provides benchmark and policy context where available, and outlines areas where coding clarity affects clinical and administrative workflows.

This piece serves clinicians, coding professionals, and policy analysts seeking a national-level overview of CPT code 49904, its clinical purpose, and the types of payer coverage contexts in which it commonly occurs. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare49904CPTreconstructive surgeryomental flapchest reconstructionflap transferoperative proceduresurgical coding

Billing Code Overview

CPT code 49904 describes the surgical creation and transfer of an omental flap: the provider opens the abdomen, prepares a flap of omentum (a fatty membrane in the abdominal cavity), and rotates that flap to fill a chest defect while preserving its vascular supply. This procedure is performed as part of reconstructive chest surgery for issues such as nonhealing wounds or complex chest wall defects.

Service type: Surgical, reconstructive flap transfer

Typical site of service: Operating room or inpatient surgical setting, with abdominal and chest operative sites

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a history of mediastinal radiation and a chronic, nonhealing chest wall wound after prior sternotomy presents for reconstructive surgery. The surgical team determines that a vascularized omental flap is required to fill a deep chest defect and promote healing. Under general anesthesia in an operating room, the surgeon performs a laparotomy to harvest an omental pedicled flap, preserving its vascular supply, then tunnels or rotates the flap into the chest wound through a diaphragmatic or subxiphoid window. Hemostasis is secured, abdominal and chest incisions are closed or left with drains as clinically indicated. Typical perioperative workflow includes preoperative imaging and wound assessment, anesthesia evaluation, intraoperative coordination between thoracic and general surgeons if needed, postoperative monitoring in PACU or ICU depending on comorbidity, pain control, wound care, and follow-up for flap viability and donor-site recovery.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documented work, time, or complexity substantially exceeds typical for `49904`.
`23`

CPT 49906: Omental Free Graft for Reconstructive Surgery

CPT-49905-OMENTAL-FLAP-REPOSITIONING-ABDOMINAL-DEFECT

CPT 49905: Omental Flap Repositioning for Abdominal Defect

CPT-49999-PERITONEUM-OMENTAL-UNLISTED-PROCEDURE

CPT 49999: Peritoneum and Omentum Unlisted Abdominal Procedure

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Taxonomy Code	Specialty	Notes
207L00000X	Surgery — General	General surgeons frequently harvest omental flaps via laparotomy.
207T00000X	Surgery — Thoracic	Thoracic surgeons commonly manage chest defect reconstruction and recipient site preparation.
207P00000X	Surgery — Plastic	Plastic and reconstructive surgeons perform chest wall reconstruction and flap inset.
208000000X	Surgery — Critical Care (Trauma)	Trauma/critical care surgeons may be involved for complex chest wall defects and postoperative critical care.
363L00000X	Colorectal Surgery	(Occasionally involved when intra-abdominal access overlaps colorectal pathology.)

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T81.31XA`	Disruption of external operation (wound) surgical site, initial encounter	Nonhealing or dehisced chest wound that may require omental flap for coverage and healing.
`L98.89`	Other specified disorders of skin and subcutaneous tissue	Chronic nonhealing chest wall ulceration where omental flap can provide vascularized tissue.
`S27.8XXA`	Other specified injuries of thorax, initial encounter	Traumatic chest wall defects that may require reconstructive coverage with omentum.
`C44.99`	Malignant neoplasm of skin of other and unspecified parts of face, head, and neck, unspecified	(If chest wall malignancy resection creates a defect requiring omental coverage.)
`Z98.890`	Other specified postprocedural states	Prior surgeries or states influencing reconstructive planning and flap selection.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19361`	Breast reconstruction with free flap or pedicle flap including donor and recipient site preparations	May be performed when chest wall defects require combined breast/chest reconstruction; can precede or follow omental flap coverage.
`15734`	Muscle, myocutaneous, or fasciocutaneous flap; trunk	Alternative or adjunct flap options for chest wall reconstruction when omentum is not used.
`49200`	Closure of abdomen, primary closure; reoperation for fascial dehiscence	Potentially performed if abdominal donor-site complications or closure concerns arise after omental harvest.
`32557`	Tube thoracostomy, includes drainage	May be performed concurrently or postoperatively for chest drainage related to chest cavity entry during flap transfer.
`36415`	Collection of venous blood by venipuncture	Common preoperative or postoperative lab service associated with the surgical episode.

OpenPayer