FeeBase
Log inGet started
Menu

Billing code 40700: Cleft lip repairMedicare rate & RVUs

Reports initial surgical reconstruction of one side of a cleft lip, including associated nasal deformity repair, for partial or complete clefts.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $911.51 for 40700 nationally in a facility.

Medicare rate · 40700

Cleft lip repair

Swap in your local Medicare rate.

Work RVUs
13.82
Total RVUs
27.29
Global days
090

National rate · 2026

$911.51

Facility setting, before claim adjustments.

See every locality for 40700 → · 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 40700 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 40700 covers

This code represents the initial reconstruction of one side of a cleft lip, with associated nasal deformity addressed as part of the repair. The surgeon restores the continuity and shape of the upper lip and may correct related nasal asymmetry during the same operation. A plastic or craniofacial surgeon typically performs the procedure in an operating room as part of congenital cleft care.

Select the code for a primary unilateral repair, whether the cleft is partial or complete; documentation should establish laterality, that the repair is primary, and the lip and nasal work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. 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 40700 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

40700 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$828.75
Alaska*Unavailable$1,127.43
ArizonaUnavailable$887.86
ArkansasUnavailable$818.54
AtlantaUnavailable$935.97
AustinUnavailable$923.76
BakersfieldUnavailable$921.67
Baltimore/Surr. CntysUnavailable$965.82
BeaumontUnavailable$872.65
BrazoriaUnavailable$893.04

40700 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
40700 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 40700 rate is calculated

Each of 40700’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 · 40700

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.82Practice expense 10.90Malpractice 2.57

27.2900 adjusted RVUs×$33.4009 conversion factor=$911.51

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 40700

40700 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40700

Cleft lip repair

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 · 40700

Cleft lip repair

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.

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

40700 without 51 · national facility

$911.51

Cleft lip repair

40700-51 · Second procedure: 50%

$455.76

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

40700 compared with similar codes

Compare codes

40700 vs 40701 vs 40702 vs 40720 vs 40761: national Medicare rates

Swap in your local Medicare rate.

  • 40700
    Cleft lip repair · 13.82 wRVU
    —
  • 40701
    Cleft lip repair · 16.8 wRVU
    —
  • 40702
    Cleft lip repair · 13.91 wRVU
    —
  • 40720
    Cleft repair · 14.35 wRVU
    —
  • 40761
    Cleft repair · 15.44 wRVU
    —

How to choose

40701Cleft lip repair
40700 is for a primary repair on one side; 40701 describes primary repair of a bilateral cleft.
40702Cleft lip repair
40700 is the initial repair. 40702 describes a secondary operation that recreates the defect before closure.
40720Cleft repair
Use 40720 for an intermediate secondary repair, not the initial unilateral repair reported with 40700.
40761Cleft repair
40761 describes extensive secondary repair requiring osteotomies; 40700 is for primary unilateral repair.

Codes related to 40700

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

Codes related to 40700
CodeHow it relatesNational office range
Same family
40701Cleft lip repairPrimary repair for a bilateral cleft lip rather than a unilateral repair.No office rate
Used instead
40702Cleft lip repairA secondary repair approach involving recreation of the defect and subsequent closure.No office rate
40720Cleft repairUsed for an intermediate secondary repair rather than the initial repair.No office rate
40761Cleft repairUsed for extensive secondary repair requiring osteotomies.No office rate
40799Unlisted procedure lipsUnlisted lip procedure code when no specific listed procedure describes the service.No office rate

40700 billing questions

When is 40700 selected instead of a secondary-repair code?

Use 40700 for the initial repair on one side, including a partial or complete cleft. Codes for secondary repair apply when the operation revises a previously repaired cleft.

Can modifier 50 be used for bilateral cleft lip repair?

No. CMS identifies bilateral adjustment as inappropriate for 40700; this code represents unilateral repair.

What postoperative care is included?

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

How are other same-session procedures paid?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and additional procedures are paid at 50%.

Can an assistant surgeon or co-surgeon be reported?

Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted.

What should the operative report establish?

Document that the repair is primary and unilateral, whether the cleft is partial or complete, and the lip and associated nasal work 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 40700PPRRVU2026_Oct_nonQPP.csv, line 4,846 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 40700 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 40700 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →