CPT CODES

CPT Code 49904

CPT code 49904 is for an omental flap procedure performed outside the abdomen, used in surgical reconstruction.

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What is CPT Code 49904

CPT code 49904 is used to describe a surgical procedure involving the creation of an omental flap that is performed outside of the abdominal cavity. This procedure typically involves mobilizing a portion of the omentum, which is a fold of peritoneum extending from the stomach, to provide coverage or support to a defect or injury in another area of the body. It is often utilized in reconstructive surgery to enhance healing or improve the function of the affected area.

Does CPT 49904 Need a Modifier?

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CPT Code 49904 Medicare Reimbursement

The CPT code 49904 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts.

Additionally, reimbursement for CPT code 49904 may vary based on the policies of the Medicare Administrative Contractor (MAC) in your region. Each MAC has the authority to interpret national Medicare policies and make local coverage determinations, which can influence whether and how a particular service is reimbursed.

Therefore, it is advisable to consult both the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 49904.

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