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Billing code 49904: Omental flapMedicare rate & RVUs

Reports transfer of vascularized omentum outside the abdominal cavity, such as to fill or reconstruct a chest-wall defect.

CMS RVU26DEffective Oct 1, 2026109 payment localities262 Medicare services in 2024

Medicare pays $1,288.27 for 49904 nationally in a facility.

Medicare rate · 49904

Omental flap

Swap in your local Medicare rate.

Work RVUs
21.79
Total RVUs
38.57
Global days
090

National rate · 2026

$1,288.27

Facility setting, before claim adjustments.

See every locality for 49904 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 49904 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

49904 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,166.51
Alaska*Unavailable$1,602.59
ArizonaUnavailable$1,251.99
ArkansasUnavailable$1,151.68
AtlantaUnavailable$1,330.38
AustinUnavailable$1,293.45
BakersfieldUnavailable$1,274.41
Baltimore/Surr. CntysUnavailable$1,368.28
BeaumontUnavailable$1,241.01
BrazoriaUnavailable$1,253.74

49904 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
49904 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

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

Swap in your local Medicare rate.

Work 21.79Practice expense 11.77Malpractice 5.01

38.5700 adjusted RVUs×$33.4009 conversion factor=$1,288.27

All indexes start 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

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)1Permitted with supporting documentation.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 49904

Omental flap

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

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

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%).

When to use modifier 51

49904 compared with similar codes

Compare codes

49904 vs 49905 vs 49906 vs 49900: national Medicare rates

Swap in your local Medicare rate.

  • 49904
    Omental flap · 21.79 wRVU
    —
  • 49905
    Omental flap · 6.38 wRVU
    —
  • 49906
    · 0 wRVU
    —
  • 49900
    Abdominal wall repair · 12.1 wRVU
    —

How to choose

49905Omental flap
The destination determines the distinction: 49904 is for transfer outside the abdominal cavity, while 49905 is for an intra-abdominal flap.
49906Free omental flap microvasc
49906 describes a free omental flap with microvascular anastomosis; 49904 is for an extra-abdominal transfer without that free-flap method.
49900Abdominal wall repair
49900 describes repair of the abdominal wall itself. It does not describe transferring omentum to an extra-abdominal recipient site.

Codes related to 49904

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 49904
CodeHow it relatesNational office range
Same family
49905Omental flapSame omental-flap family; the transfer remains within the abdominal cavity.No office rate
Used instead
49906Free omental flap microvascFor a free omental flap transferred using microvascular anastomosis.No office rate
49999Unlisted px abd pertm&omnUnlisted abdominal, peritoneal, or omental procedure code when no specific code describes the service.No office rate

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
RVUs for 49904PPRRVU2026_Oct_nonQPP.csv, line 5,861 (RVU26D)

Open CMS sourceHow we calculate rates

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