CPT 40500: Lip excisionMedicare rate & RVUs

Medicare pays $527.73 for 40500 nationally in the office and $333.01 in a hospital or facility. Local office rates run $467.31–$695.40.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 40500 covers

This service removes a full-thickness segment of the upper or lower lip and closes the resulting defect primarily, without using a flap for reconstruction. It may be performed for a localized lip lesion or neoplasm when the required excision extends through the lip. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons may perform the operation in an operating room or an appropriately equipped outpatient surgical setting.

Choose this code when the operative report supports full-thickness excision and direct closure; document the site, extent of tissue removed, indication, and closure method. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 40500 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

40500 rates by state

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

How the 40500 rate is calculated

Each of 40500’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.

Payment rules and modifiers for 40500

40500 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

40500 compared with similar codes

How to choose

40510Lip excision

40500 represents full-thickness lip excision with primary closure. Use 40510 when the operative report supports its distinct excision and closure approach.

40520Lip excision

Both are lip excision codes, but 40500 is for direct primary closure; 40520 reflects a different operative approach.

40525Lip reconstruction

40500 describes excision followed by primary closure. 40525 is a reconstruction code for a defect requiring a reconstructive approach.

Codes related to 40500

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

Open CMS sourceHow we calculate rates