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CPT code 40799: Lip procedure, no listed procedure2026 Medicare rate & RVUs

CPT 40799 identifies an unlisted lip procedure when no listed lip code represents the work performed; Medicare contractors price each claim.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 40799

Lip procedure, no listed procedure

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
YYY

National rate · 2026

—

Not priced in the facility setting.

See every locality for 40799 →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 40799 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 40799 covers

40799 is the CPT code for an unlisted procedure involving the lips. It is used when the work performed is not represented by a listed lip procedure; it does not identify a particular repair technique or cleft-lip operation. Listed options include primary cleft-lip repairs, secondary repair, and repair using a cross-lip flap. When a listed code describes the procedure, report that code rather than 40799. The operative report should describe the procedure, its purpose, and the extent of the work so the unlisted service can be evaluated.

Medicare assigns status C, or carrier priced: CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. The contractor also sets the global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are paid at 50% under the standard multiple-procedure reduction.

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 40799 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

40799 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

40799 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
40799 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 40799 rate is calculated

Each of 40799’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 · 40799

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

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

Payment rules and modifiers for 40799

The CMS indicators that decide how 40799 is paid alongside other services.

CMS payment indicators · 40799

Lip procedure, no listed procedure

RuleCMS valueWhat it means
Global periodYYYThe Medicare contractor sets the global period.
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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)1Permitted with supporting documentation.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

40799 without 51 · national facility

$0.00

Lip procedure, no listed procedure

40799-51 · Second procedure: 50%

$0.00

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

40799 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 40799

    Lip procedure, no listed procedure0 wRVU

    Not priced

  • 40700

    Cleft lip repair, primary, unilateral13.82 wRVU

    Not priced

  • 40701

    Cleft lip repair, primary, bilateral16.8 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

How to choose

40700Cleft lip repairPrimary, unilateral
40700 describes primary incomplete cleft-lip repair. Use 40799 only when no listed code describes the lip procedure performed.
40701Cleft lip repairPrimary, bilateral
40701 describes primary complete cleft-lip repair. It is the specific choice when that repair matches the procedure.
40702Cleft lip repairSecondary, bilateral, under age four
40702 describes one-stage bilateral primary cleft-lip repair. Use 40799 only when the procedure does not fit a listed code.
40720Cleft repairAdolescent or adult revision
40720 describes secondary cleft-lip repair. Use 40799 when no listed lip procedure represents the work performed.

Codes related to 40799

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

Codes related to 40799
CodeHow it relatesNational office range
Used instead
40700Cleft lip repair, primary, unilateralListed option for primary incomplete cleft-lip repair.No office rate
40701Cleft lip repair, primary, bilateralListed option for primary complete cleft-lip repair.No office rate
40702Cleft lip repair, secondary, bilateral, under age fourListed option for one-stage bilateral primary cleft-lip repair.No office rate
40720Cleft repair, adolescent or adult revisionListed option for secondary cleft-lip repair.No office rate
40761Cleft repair, secondary cross-lip flapListed option for cleft-lip repair using a cross-lip flap.No office rate

40799 billing questions

When should 40799 be used instead of a listed cleft-lip repair code?

Use 40799 when no listed code describes the lip procedure performed. Select the specific listed code when it matches the work.

What documentation should accompany 40799?

The operative report should describe the procedure, its purpose, and the extent of the work so the unlisted service can be evaluated.

How does 40799 differ from the listed cleft-lip repair codes?

Codes 40700, 40701, and 40702 describe primary repairs with different specifications; 40720 describes secondary repair, and 40761 involves a cross-lip flap. Use 40799 only when a listed code does not describe the procedure.

How does Medicare price 40799?

Medicare assigns status C, or carrier priced. The Medicare Administrative Contractor sets payment for each claim and determines the global period.

Does the multiple-procedure reduction affect 40799?

Yes. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.

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

Open CMS sourceHow we calculate rates

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