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Billing code 40527: Lip reconstructionMedicare rate & RVUs

Reconstructs a full-thickness lip defect by transferring tissue from the opposite lip, typically when primary closure or a local flap is unsuitable.

CMS RVU26DEffective Oct 1, 2026109 payment localities41 Medicare services in 2024

Medicare pays $553.45 for 40527 nationally in a facility.

Medicare rate · 40527

Lip reconstruction

Work RVUs
9.09
Total RVUs
16.57
Global days
090

National rate · 2026

$553.45

Facility setting, before claim adjustments.

See every locality for 40527 →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.

On this page 10 sections
  1. Medicare rate
  2. What 40527 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 40527 covers

This procedure rebuilds a full-thickness defect of the upper or lower lip using a flap of tissue transferred from the opposite lip. The flap remains attached to its donor site initially, creating a temporary connection between the lips. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons may use this approach for defects after tumor removal or trauma when local tissue cannot provide adequate reconstruction. The service is generally performed in a facility setting.

Report the code when the operative documentation supports reconstruction with a cross-lip flap, rather than a different flap or graft method. Document the defect, donor and recipient sites, and the flap technique. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and the others are subject to the standard reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; 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 40527 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

40527 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$508.60
Alaska*Unavailable$698.84
ArizonaUnavailable$540.73
ArkansasUnavailable$503.06
AtlantaUnavailable$566.52
AustinUnavailable$560.97
BakersfieldUnavailable$561.73
Baltimore/Surr. CntysUnavailable$583.78
BeaumontUnavailable$531.81
BrazoriaUnavailable$544.33

40527 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
40527 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 40527 rate is calculated

Each of 40527’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 · 40527

RVUs × geographic indexes × conversion factor

Work9.09

9.09 RVUs× 1.000 GPCI

Practice expense6.16

6.16 RVUs× 1.000 GPCI

Malpractice1.32

1.32 RVUs× 1.000 GPCI

Adjusted RVUs

16.5700

Conversion factor

$33.4009

Medicare rate

$553.45

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

Payment rules and modifiers for 40527

40527 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40527

Lip reconstruction

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)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
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 · 40527

Lip reconstruction

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

40527 without 51 · national facility

$553.45

Lip reconstruction

40527-51 · Second procedure: 50%

$276.73

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

40527 compared with similar codes

Compare codes · National

4 codes, side by side

  • 40527

    Lip reconstruction9.09 wRVU

    Not priced

  • 40525

    Lip reconstruction7.53 wRVU

    Not priced

  • 40530

    Lip excision5.4 wRVU

    $565.81

  • 40510

    Lip excision4.7 wRVU

    $498.34

How to choose

40525Lip reconstruction
Use 40527 when tissue is transferred from the opposite lip as a cross-lip flap. Use 40525 when the documented reconstruction uses another local flap.
40530Lip excision
40530 describes lip excision with reconstruction by graft; 40527 is for reconstruction with a cross-lip flap.
40510Lip excision
40510 involves lip excision with local-flap reconstruction. 40527 identifies the distinct cross-lip flap technique.

Codes related to 40527

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

Codes related to 40527
CodeHow it relatesNational office range
Same family
40525Lip reconstructionLip reconstruction using a local flap other than the cross-lip flap represented by 40527.No office rate
Used instead
40530Lip excisionLip excision and reconstruction by a graft is a different method from cross-lip flap reconstruction.$501.58–$729.99
40510Lip excisionLip excision with local-flap reconstruction uses a different reconstructive approach.$442.28–$645.61

40527 billing questions

How does this differ from 40525?

40527 is for reconstruction using a cross-lip flap, which transfers tissue from the opposite lip. Choose 40525 when the documented reconstruction uses a different local flap technique.

Is the flap reported separately?

The cross-lip flap is the reconstructive method represented by 40527. Do not report a separate flap service for the same reconstruction.

Should modifier 50 be used when both lips are involved?

No. Modifier 50 is inappropriate for this code; document the cross-lip reconstruction and the donor and recipient sites.

When is an assistant surgeon payable?

Assistant-at-surgery payment is allowed only when the record documents medical necessity. Co-surgeons and team surgery are not permitted for this code.

What postoperative care is included?

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

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 40527PPRRVU2026_Oct_nonQPP.csv, line 4,827 (RVU26D)

Open CMS sourceHow we calculate rates

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