No office rate
The destination determines the distinction: 49904 is for transfer outside the abdominal cavity, while 49905 is for an intra-abdominal flap.
On this page
CMS RVU26D · Effective 2026-10-01
49904 Omental flap Medicare reimbursement rates in Guam
Reports transfer of vascularized omentum outside the abdominal cavity, such as to fill or reconstruct a chest-wall defect. Compare 49904 office and facility rates across CMS payment localities in Guam.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 49904 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1271.68
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Reconstructive surgery
About 49904: Extra-abdominal omental flap transfer
Reports transfer of vascularized omentum outside the abdominal cavity, such as to fill or reconstruct a chest-wall defect.
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.
CMS billing rules for 49904
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery paid only with supporting documentation.
Where the value comes from
- Work RVU21.79 · 56%
- Practice expense (office) RVU11.77 · 31%
- Malpractice RVU5.01 · 13%
262
Medicare services in 2024 · #4100 by national volume
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.
49904 compared with similar codes
Office rates for Guam, from the same CMS release.
49906
No office rateFree omental flap microvasc
49906 describes a free omental flap with microvascular anastomosis; 49904 is for an extra-abdominal transfer without that free-flap method.
No office rate
49900 describes repair of the abdominal wall itself. It does not describe transferring omentum to an extra-abdominal recipient site.
Compare 49904 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$1271.68
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 49904 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,861
- Code
- 49904
- Physician work
- 21.79
- Practice expense
- 11.77
- Malpractice
- 5.01
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.79 | × 1.000 | 21.7900 |
| Practice expense | 11.77 | × 1.137 | 13.3825 |
| Malpractice | 5.01 | × 0.579 | 2.9008 |
| Total RVUs | 38.0733 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$1271.68
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.79 | 1 |
| Practice expense | 11.77 | 1.137 |
| Malpractice | 5.01 | 0.579 |
(21.79 × 1 + 11.77 × 1.137 + 5.01 × 0.579) × $33.4009 = $1271.68
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,85849651,,Lap ing hernia repair recur,A,,8.17,6.15,NA,6.15,,2.15,16.47,16.47,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,85949659,,Unlstd laps px hrnap hrnrphy,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,86049900,,Repair of abdominal wall,A,,12.10,8.82,NA,8.82,,3.04,23.96,23.96,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,86149904,,Omental flap extra-abdom,A,,21.79,11.77,NA,11.77,,5.01,38.57,38.57,0,090,0.10,0.80,0.10,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,86249905,,Omental flap intra-abdom,A,,6.38,1.57,NA,1.57,,1.48,9.43,9.43,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,86349906,,Free omental flap microvasc,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,090,0.09,0.81,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,86449999,,Unlisted px abd pertm&omn,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014