CPT code 49999: Unlisted abdominal procedure, abdomen, peritoneum, omentum2026 Medicare rate & RVUs in Pennsylvania
Report 49999 for an abdominal, peritoneal, or omental operation when no listed CPT procedure accurately describes the service performed.
CMS doesn’t publish an office rate for 49999 in Pennsylvania.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 49999 covers
CPT 49999 is the unlisted code for surgical work involving the abdomen, peritoneum, or omentum when no listed CPT procedure describes the service. A surgeon may report it for an abdominal operation that does not fit a more specific code, including work on abdominal or omental tissue. The operative report should identify the procedure performed, the anatomy involved, and the work done so the Medicare contractor can evaluate and price the claim.
Medicare assigns status C, meaning CMS publishes no national payment and the Medicare Administrative Contractor sets payment for each claim. The contractor also determines the global period. For procedures performed in the same session, the standard multiple procedure reduction applies: the highest-valued procedure is paid in full and the other procedures are paid at 50%. Compare the service with listed abdominal wall and omental flap codes before using this unlisted code.
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 49999 pays more and less in Pennsylvania
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Philadelphia, PA | Unavailable | Unavailable |
| Rest of Pennsylvania | Unavailable | Unavailable |
How the 49999 rate is calculated
Each of 49999’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 · 49999
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 49999
The CMS indicators that decide how 49999 is paid alongside other services.
CMS payment indicators · 49999
Unlisted abdominal procedure, abdomen, peritoneum, omentum
| Rule | CMS value | What it means |
|---|---|---|
| Global period | YYY | The Medicare contractor sets the global period. |
| 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
49999 without 51 · national facility
$0.00
Unlisted abdominal procedure, abdomen, peritoneum, omentum
49999-51 · Second procedure: 50%
$0.00
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%).
49999 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 49900Abdominal wall repairIncision disruption or evisceration
- 49900 describes abdominal wall repair. Use 49999 only when that listed repair code does not describe the operation.
- 49904Omental flapExtra-abdominal transfer
- 49904 describes an extra-abdominal omental flap procedure. Report 49999 when the operation does not match that listed service.
- 49905Omental flapIntra-abdominal placement
- 49905 describes an intra-abdominal omental flap procedure. Report 49999 when the operation does not match that listed service.
- 49906Free omental flapMicrovascular anastomosis
- 49906 describes a free omental flap with microvascular work. Use 49999 when that specific service does not describe the procedure.
49999 billing questions
When should I report 49999 instead of a listed abdominal procedure?
Use 49999 when no listed CPT procedure accurately describes the operation performed. If a specific code describes the service, report that code instead.
What documentation supports a claim for 49999?
The operative report should identify the procedure performed, the anatomy involved, and the work done so the Medicare contractor can evaluate and price the claim.
How does Medicare price 49999?
Status C means CMS publishes no national payment. The Medicare Administrative Contractor sets payment for each claim.
Does 49999 have a nationally set global period?
The Medicare contractor sets the global period for this code.
How are multiple procedures treated when 49999 is reported?
For procedures performed in the same session, the standard multiple procedure reduction applies: the highest-valued procedure is paid in full and the other procedures are paid at 50%.
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
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