Summary & Overview
CPT 49906: Omental Free Graft for Reconstructive Surgery
CPT code 49906 represents microsurgical harvest and transfer of an omental free flap for reconstruction of defects in locations such as the breast, head and neck, or extremities. This complex procedure involves detaching the omentum from its native abdominal vasculature and reconnecting vessels at the recipient site using an operative microscope. Nationally, the code matters because it denotes high-complexity reconstructive surgery with significant operative time, specialized surgical skill, and resource intensity, all of which affect coding, reimbursement, and utilization monitoring for payers and health systems.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of the omental free graft, common sites of service, and the service type. The publication provides benchmarks where available, summarizes policy and coverage considerations affecting access and coding practice, and highlights billing and documentation elements relevant to payers and providers. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 49906 describes a surgical procedure in which the provider harvests a flap of omentum as a free graft by detaching it from its abdominal vascular supply and transferring it to reconstruct defects at a separate site. The procedure requires microsurgical technique, using an operative microscope and fine instruments to perform vascular anastomoses at the recipient location.
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Service type: Microsurgical free omental graft for reconstructive surgery
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Typical site of service: Operating room, commonly for reconstruction of the breast, head and neck, or extremities
Clinical & Coding Specifications
Clinical Context
A 54-year-old female with a history of locally advanced left-breast cancer undergoes mastectomy with planned immediate autologous reconstruction. The reconstructive surgeon harvests a free omental flap (49906) from the abdominal cavity, detaching it from its native vascular pedicle and preparing it as a free graft. Microvascular anastomosis is performed at the chest to revascularize the omental tissue and fill a deep chest wall defect following oncologic resection. The perioperative workflow includes preoperative imaging and marking, general endotracheal anesthesia, intraoperative antibiotic prophylaxis, abdomen access and omentum harvest, microsurgical transfer and vessel anastomosis under an operative microscope, intraoperative flap perfusion assessment, and postoperative monitoring in a surgical recovery unit or intensive care setting for flap viability and hemodynamic stability.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for 49906 due to complexity, documented in operative report. |