CPT 49905, in plain terms, covers Add-on for creating an omental flap used inside the abdomen, reported in addition to the primary abdominal procedure. CPT 49905 is referenced in 3 tracked payer policy changes from Blue Cross Blue Shield of Nebraska and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 49905 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 49905 on AAPC
Blue Cross Blue Shield of Nebraska is implementing a new medical policy requiring preauthorization for all tissue transfer (flap) procedures starting May 1, 2026. The policy covers 33 specific CPT codes and will use Interqual criteria for approval decisions.
Blue Cross and Blue Shield of Nebraska is implementing a new medical policy (III.274) for tissue transfer (flap) procedures effective May 1, 2026. Starting that date, preauthorization will be required for all tissue transfer flap procedures, and Interqual Criteria will be used for clinical review. The policy affects 24 specific CPT codes related to various flap procedures across multiple anatomical locations.
Aetna considers pancreaticoduodenectomy (Whipple resection) medically necessary for ampullary adenoma or carcinoma, cholangiocarcinoma, chronic pancreatitis, combined pancreatic and duodenal injury, duodenal neoplasm, intraductal papillary mucinous neoplasm of the pancreas with high-grade dysplasia or invasive cancer, neuroendocrine tumors, and pancreatic adenocarcinoma. Aetna considers Whipple resection experimental, investigational, or unproven for Zollinger-Ellison syndrome. Immuno-nutrition, intraoperative liquid biopsy for detecting R1 resection, intraoperative pancreas stump perfusion assessment, and pre-operative biliary drainage with an omental flap for preventing complications are listed as experimental, investigational, or unproven.
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