CPT code 49904: Omental flap, extra-abdominal transfer2026 Medicare rate & RVUs in Missouri
Reports transfer of vascularized omentum outside the abdominal cavity, such as to fill or reconstruct a chest-wall defect.
CMS doesn’t publish an office rate for 49904 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 49904 covers
The surgeon mobilizes vascularized omentum and transfers it beyond the abdominal cavity to cover a defect or fill dead space. A common application is reconstruction of the chest wall, including coverage of a complex thoracic defect. The procedure is typically performed by a general, thoracic, or reconstructive surgeon in a hospital operating room; the operative report should identify the flap’s destination and how it was transferred.
Select this code when the omental flap is transferred to an extra-abdominal site. Distinguish an intra-abdominal transfer from a free flap requiring microvascular anastomosis. Documentation should describe the omentum mobilized, its route and recipient site, and the reconstructive purpose. Medicare assigns major-surgery status: the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery; co-surgeon and team-surgery payment requires supporting documentation.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 49904 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $1,260.44 |
| Metropolitan St. Louis, MO | Unavailable | $1,269.74 |
| Rest of Missouri | Unavailable | $1,229.67 |
How the 49904 rate is calculated
Each of 49904’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 49904
RVUs × geographic indexes × conversion factor
Work21.79
21.79 RVUs× 1.000 GPCI
Practice expense11.77
11.77 RVUs× 1.000 GPCI
Malpractice5.01
5.01 RVUs× 1.000 GPCI
Adjusted RVUs
38.5700
Conversion factor
$33.4009
Medicare rate
$1,288.27
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49904
49904 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 49904
Omental flap, extra-abdominal transfer
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 49904
Omental flap, extra-abdominal transfer
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49904 without 51 · national facility
$1,288.27
Omental flap, extra-abdominal transfer
49904-51 · Second procedure: 50%
$644.14
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
49904 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 49905Omental flapIntra-abdominal placement
- The destination determines the distinction: 49904 is for transfer outside the abdominal cavity, while 49905 is for an intra-abdominal flap.
- 49906Free omental flapMicrovascular anastomosis
- 49906 describes a free omental flap with microvascular anastomosis; 49904 is for an extra-abdominal transfer without that free-flap method.
- 49900Abdominal wall repairIncision disruption or evisceration
- 49900 describes repair of the abdominal wall itself. It does not describe transferring omentum to an extra-abdominal recipient site.
49904 billing questions
How is this code distinguished from 49905?
Use 49904 when the omental flap is transferred outside the abdominal cavity. Code 49905 describes an intra-abdominal transfer.
When is 49906 the better choice?
Use 49906 for a free omental flap transferred with microvascular anastomosis. This code describes an extra-abdominal flap that is not the free microvascular flap service.
What should the operative report document?
Document the omentum mobilized, the transfer route, the recipient site, and the reconstructive purpose. The report should make clear that the flap was placed outside the abdominal cavity.
Can modifier 50 be reported?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate for the described anatomy and service.
How does the global period affect postoperative billing?
The 90-day major-surgery global includes the day-before preoperative visit and 90 days of related postoperative care.
How are assistant and co-surgeon claims handled?
Medicare does not pay an assistant at surgery for this code. Co-surgeon or team-surgery payment requires supporting documentation.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 49904 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist