CPT code 40799: Lip procedure, no listed procedure2026 Medicare rate & RVUs in Texas
CPT 40799 identifies an unlisted lip procedure when no listed lip code represents the work performed; Medicare contractors price each claim.
CMS doesn’t publish an office rate for 40799 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | Unavailable |
| Beaumont, TX | Unavailable | Unavailable |
| Brazoria, TX | Unavailable | Unavailable |
| Dallas, TX | Unavailable | Unavailable |
| Fort Worth, TX | Unavailable | Unavailable |
| Galveston, TX | Unavailable | Unavailable |
| Houston, TX | Unavailable | Unavailable |
| Rest of Texas | Unavailable | Unavailable |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | YYY | The Medicare contractor sets the global period. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| Professional/technical | 0 | Physician 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%).
40799 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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