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CPT code 40701: Cleft lip repair, primary, bilateral2026 Medicare rate & RVUs

Reports initial surgical repair of a bilateral cleft lip with associated nasal deformity, typically performed by a plastic or craniofacial surgeon.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,065.15 for 40701 nationally in a facility.

Medicare rate · 40701

Cleft lip repair, primary, bilateral

Office or facility?

Work RVUs
16.8
Total RVUs
31.89
Global days
090

National rate · 2026

$1,065.15

Facility setting, before claim adjustments.

See every locality for 40701 →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.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 40701 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 40701 covers

This code describes the initial operative reconstruction of a cleft involving both sides of the lip, with repair of the associated nasal deformity. It is typically performed by a plastic, craniofacial, or oral and maxillofacial surgeon in an operating room, often as part of an infant’s cleft-care plan. The work addresses the bilateral defect in the same operation rather than a later revision of a prior repair.

Report the code when the operative record supports a primary repair and bilateral involvement; document the defect and the reconstruction performed. The code is priced as bilateral, so modifier 50 does not increase payment. It has a 90-day global period that includes the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.

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 40701 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

40701 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$970.05
AlaskaUnavailable$1,325.09
ArizonaUnavailable$1,037.79
ArkansasUnavailable$958.35
Atlanta, GAUnavailable$1,094.12
Austin, TXUnavailable$1,077.64
Bakersfield, CAUnavailable$1,073.61
Baltimore area, MDUnavailable$1,127.96
Beaumont, TXUnavailable$1,021.77
Brazoria, TXUnavailable$1,043.19

40701 rates by state

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

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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
40701 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 40701 rate is calculated

Each of 40701’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 · 40701

RVUs × geographic indexes × conversion factor

Office or facility?

Work16.80

16.80 RVUs× 1.000 GPCI

Practice expense11.98

11.98 RVUs× 1.000 GPCI

Malpractice3.11

3.11 RVUs× 1.000 GPCI

Adjusted RVUs

31.8900

Conversion factor

$33.4009

Medicare rate

$1,065.15

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 40701

40701 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40701

Cleft lip repair, primary, bilateral

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)2Already bilateral by definition: paid once at 100%.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 40701

Cleft lip repair, primary, bilateral

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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

40701 without 51 · national facility

$1,065.15

Cleft lip repair, primary, bilateral

40701-51 · Second procedure: 50%

$532.58

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

40701 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 40701

    Cleft lip repair, primary, bilateral16.8 wRVU

    Not priced

  • 40700

    Cleft lip repair, primary, unilateral13.82 wRVU

    Not priced

  • 40702

    Cleft lip repair, secondary, bilateral, under age four13.91 wRVU

    Not priced

  • 40720

    Cleft repair, adolescent or adult revision14.35 wRVU

    Not priced

  • 40761

    Cleft repair, secondary cross-lip flap15.44 wRVU

    Not priced

How to choose

40700Cleft lip repairPrimary, unilateral
40700 is for a primary unilateral repair. Choose 40701 when the initial repair addresses both sides.
40702Cleft lip repairSecondary, bilateral, under age four
40702 describes a secondary unilateral repair; 40701 is for the initial bilateral repair.
40720Cleft repairAdolescent or adult revision
40720 is for secondary bilateral repair, while 40701 describes the primary bilateral operation.
40761Cleft repairSecondary cross-lip flap
40761 describes a secondary major revision. It is not the code for an initial bilateral repair.

Codes related to 40701

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

Codes related to 40701
CodeHow it relatesNational office range
Same family
40700Cleft lip repair, primary, unilateralPrimary unilateral cleft lip/nasal deformity repair.No office rate
40702Cleft lip repair, secondary, bilateral, under age fourSecondary unilateral repair, rather than primary bilateral repair.No office rate
40720Cleft repair, adolescent or adult revisionSecondary bilateral cleft lip/nasal deformity repair.No office rate
40761Cleft repair, secondary cross-lip flapUsed for a secondary major revision of a cleft lip/nasal deformity.No office rate
Used instead
40799Lip procedure, no listed procedureUnlisted lip procedure code when no listed code describes the service.No office rate

40701 billing questions

When should 40701 be selected instead of 40700?

Use 40701 for a primary repair involving both sides. Code 40700 describes a primary unilateral repair.

Should modifier 50 be appended for bilateral repair?

The code is already priced as bilateral, and modifier 50 does not increase payment.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure reduction.

Can an assistant surgeon be reported?

CMS permits payment for an assistant at surgery. Co-surgeons and team surgery are not permitted for this code.

What documentation supports primary bilateral repair?

The operative report should establish that this is the initial repair, describe the bilateral cleft and associated nasal deformity, and document the reconstruction performed.

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 40701PPRRVU2026_Oct_nonQPP.csv, line 4,847 (RVU26D)

Open CMS sourceHow we calculate rates

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