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    v1.0.30
    OpenPayerBilling CodesSurgical Procedures on the Omental FlapCPT cpt-49904-omental-flap-rotation-for-chest-reconstruction
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    CPT 49904: Omental Flap Rotation for Chest Reconstruction

    Medicare pays $1303 on average nationally for this procedure.

    CPT code 49904 describes creation and transfer of an omental flap by opening the abdomen and preparing the omentum to fill a chest defect, with rotation of the flap while preserving its vascular supply; this is a reconstructive surgical procedure typically performed in an operating room for chest wall or sternal wound coverage and nonhealing chest wounds.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    Table of contents

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    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.

    Related CPT Codes

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

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207T00000X
    207P00000X
    208000000X
    363L00000X
    213ES0000X
    163WP0218X
    331L00000X

    Related Payer Policy Updates

    Specialty: General Surgery1 / 2

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

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

    CPT 49905: Omental Flap Rotation (Omentoplasty) Preserving Vascular Supply

    CPT-49906-OMENTAL-FREE-GRAFT-MICROSURGICAL-RECONSTRUCTION

    CPT 49906: Omentum Free Flap, Microvascular Reconstruction

    CPT-49999-PERITONEUM-OMENTAL-UNLISTED-PROCEDURE

    CPT 49999: Peritoneum and Omentum Procedure, Unlisted

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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