CPT 49905 Omental Flap Repositioning Reimbursement | OpenPayer

Summary & Overview

CPT 49905: Omental Flap Repositioning for Abdominal Defect

CPT code 49905 represents the surgical repositioning of an omental flap to fill an intra-abdominal defect while maintaining the flap's vascular supply. This reconstructive technique is used in a range of abdominal operations to promote wound healing, provide vascularized tissue coverage, and protect viscera when primary closure is not possible. As a specialized operative procedure, coding accuracy affects institutional surgical coding, episode payments, and clinical documentation.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national perspective on clinical context, coding considerations, and payer coverage trends. Readers will find benchmarks for utilization, guidance on common clinical scenarios where an omental flap is indicated, and summaries of relevant policy updates that can affect prior authorization and reimbursement pathways. Where payer-specific policy text is unavailable in the input, the report notes that details are not provided.

The report is intended for hospital billing teams, surgical chiefs, revenue cycle managers, and clinical documentation specialists who need a concise reference to the procedure, its clinical rationale, and the landscape of payer coverage. Data not available in the input is clearly identified so readers can seek payer policy documents or local coding guidance as needed.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 49905omental flapabdominal surgeryreconstructive surgeryoperative proceduresurgical codingclinical documentationinpatient surgeryoutpatient surgery

Billing Code Overview

CPT code 49905 describes the surgical repositioning of an omental flap to fill a defect within the abdominal cavity while preserving the flap's vascular supply. The procedure involves mobilizing and rotating a segment of omentum — a fatty, vascularized membrane that drapes over the abdominal organs — into a defect created or exposed during abdominal surgery.

Service type: Surgical, reconstructive abdominal procedure

Typical site of service: Operating room (inpatient or outpatient surgical setting)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 58-year-old male undergoes an exploratory laparotomy for a complicated ventral hernia with incarcerated small bowel. During the operation the surgeon discovers a segmental abdominal wall defect after resection of nonviable tissue. To fill and reinforce the defect and promote vascularized tissue coverage, the surgeon mobilizes a pedicled omental flap and repositions it into the abdominal defect, preserving its vascular supply. The procedure is performed in an operating room under general anesthesia. Typical workflow: preoperative assessment and informed consent, induction of anesthesia, midline laparotomy, identification and preparation of omental flap, rotation and inset of the omentum into the defect, hemostasis and closure of the abdominal wall, postoperative monitoring in the PACU, and inpatient surgical ward follow-up with wound checks and routine post-laparotomy care. Usual sites of service are the hospital operating room with inpatient admission; this may also occur during an emergency laparotomy in an acute care hospital setting.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When work, time, or complexity substantially exceeds typical for `49905` (document rationale).

CPT 49906: Omental Free Graft for Reconstructive Surgery

CPT-49904-OMENTAL-FLAP-ROTATION-FOR-CHEST-RECONSTRUCTION

CPT 49904: Omental Flap Transfer for Chest Reconstruction

CPT-49999-PERITONEUM-OMENTAL-UNLISTED-PROCEDURE

CPT 49999: Peritoneum and Omentum Unlisted Abdominal Procedure

23

Taxonomy Code	Specialty	Notes
208D00000X	General Surgery	Most commonly performs abdominal wall repairs and omental flap repositioning.
207P00000X	Colon & Rectal Surgery	May perform omental repositioning during complex colorectal resections or pelvic reconstructions.
208600000X	Surgical Oncology	Performs during oncologic resections when vascularized omentum is used to fill defects after tumor resection.
208000000X	Obstetrics & Gynecology	Gynecologic oncologists or complex pelvic surgeons may use omental flaps in pelvic reconstruction.
207L00000X	Acute Care Surgery	Trauma and acute care surgeons commonly use omental flaps in emergent abdominal repairs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K43.2`	Ventral hernia with obstruction, without gangrene	Ventral hernia defects often require tissue coverage; omental flap can fill the defect and promote healing.
`K43.9`	Ventral hernia without obstruction or gangrene	Omental repositioning may be used during repair of complex ventral/incisional hernias.
`K91.89`	Other postprocedural complications and disorders of the digestive system	Used when addressing post-surgical abdominal wall defects or complications requiring omental coverage.
`K65.9`	Peritonitis, unspecified	Omentum may be mobilized to control contamination or fill defects after debridement for peritonitis.
`C18.9`	Malignant neoplasm of colon, unspecified	After oncologic resection leaving a defect, omental flap may be used to fill pelvic/abdominal cavity defects.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49560`	Repair initial inguinal hernia, age 5 years or older; reducible	Hernia repair may be performed in the same operative setting when the abdominal wall defect originates from hernia recurrence; not specific to omental flap but may be part of the same case.
`49568`	Repair recurrent incisional or ventral hernia; reducible	Commonly performed alongside or preceding omental flap repositioning when reconstructing a ventral/incisional hernia with tissue loss.
`15734`	Muscle, myocutaneous or fasciocutaneous flap; trunk	Used when a more complex fascial or muscle flap is required in addition to or instead of omental repositioning for abdominal wall reconstruction.
`49010`	Exploration of peritoneal cavity, open; diagnostic, with or without bioptic sampling	Often performed prior to definitive repair to assess intra-abdominal pathology and determine need for omental flap.
`35800`	Free muscle or myocutaneous flap with microvascular anastomosis	Performed when microvascular free tissue transfer is required as an alternative to pedicled omental flap for large complex defects.

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