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Billing code 40761: Cleft repairMedicare rate & RVUs

Reports secondary cleft lip and nasal reconstruction using tissue transferred from the opposite lip, including closure of the flap donor site.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $962.61 for 40761 nationally in a facility.

Medicare rate · 40761

Cleft repair

Swap in your local Medicare rate.

Work RVUs
15.44
Total RVUs
28.82
Global days
090

National rate · 2026

$962.61

Facility setting, before claim adjustments.

See every locality for 40761 → · 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 40761 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 40761 covers

This operation rebuilds a previously repaired cleft lip and associated nasal deformity using a cross-lip flap: tissue from one lip is transferred to restore deficient tissue in the other. The surgeon also closes the flap donor site as part of the service. Plastic surgeons and cleft-craniofacial surgeons typically perform this reconstruction in an operating room when a prior repair leaves a lip or nasal defect that calls for flap tissue rather than direct reclosure.

Select the code when the documented secondary repair uses a cross-lip flap for cleft lip/nasal reconstruction; a routine primary repair or secondary repair by direct recreation and closure is a different service. The operative report should identify the defect, flap design and transfer, repaired lip/nasal structures, and donor-site closure. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant-at-surgery service, and 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 40761 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

40761 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$877.13
Alaska*Unavailable$1,200.25
ArizonaUnavailable$937.93
ArkansasUnavailable$866.62
AtlantaUnavailable$989.05
AustinUnavailable$973.08
BakersfieldUnavailable$968.63
Baltimore/Surr. CntysUnavailable$1,019.21
BeaumontUnavailable$924.21
BrazoriaUnavailable$942.49

40761 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
40761 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 40761 rate is calculated

Each of 40761’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 · 40761

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 15.44Practice expense 10.51Malpractice 2.87

28.8200 adjusted RVUs×$33.4009 conversion factor=$962.61

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

Payment rules and modifiers for 40761

40761 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40761

Cleft 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)1Not paid (statutory restriction).
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 · 40761

Cleft 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

40761 without 51 · national facility

$962.61

Cleft repair

40761-51 · Second procedure: 50%

$481.31

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

40761 compared with similar codes

Compare codes

40761 vs 40720 vs 40702 vs 40700: national Medicare rates

Swap in your local Medicare rate.

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

How to choose

40720Cleft repair
Both describe secondary cross-lip flap reconstruction. 40761 applies when the service includes cleft nasal repair; 40720 is for the corresponding lip repair without nasal repair.
40702Cleft lip repair
Use 40702 for secondary cleft lip repair by recreating and closing the defect. Use 40761 when reconstruction uses a cross-lip flap and includes nasal repair.
40700Cleft lip repair
40700 is a primary unilateral cleft lip repair. 40761 is secondary reconstruction using a cross-lip flap, with nasal repair included.

Codes related to 40761

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

Codes related to 40761
CodeHow it relatesNational office range
Same family
40720Cleft repairSecondary cross-lip flap repair of cleft lip without the nasal repair represented by 40761.No office rate
40702Cleft lip repairSecondary cleft lip repair by recreating the defect and closing it, rather than using a cross-lip flap.No office rate
40700Cleft lip repairPrimary unilateral cleft lip repair, not secondary flap reconstruction.No office rate
40701Cleft lip repairPrimary bilateral cleft lip repair, not secondary flap reconstruction.No office rate

40761 billing questions

How is this different from 40720?

40761 is for secondary cleft lip/nasal repair with a cross-lip flap. Use 40720 for the corresponding secondary cross-lip repair when nasal repair is not part of the service.

Can this be reported for a direct revision without a flap?

No. This code describes reconstruction using a cross-lip flap; secondary repair by recreating the defect and closing it is represented by a different code.

Is the flap donor-site closure separately reported?

No. Closure of the donor site is included in this service.

Should modifier 50 be used for bilateral anatomy?

No. CMS identifies bilateral adjustment as inappropriate for this code.

What global care is included?

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

Can an assistant or co-surgeon be billed?

Medicare does not pay an assistant-at-surgery service for this code. Co-surgeons and team surgery are not permitted.

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 40761PPRRVU2026_Oct_nonQPP.csv, line 4,853 (RVU26D)

Open CMS sourceHow we calculate rates

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