$485.16
40510 is for full-thickness excision that does not require reconstruction. 40530 includes free-flap reconstruction of the excision defect.
On this page
CMS RVU26D · Effective 2026-10-01
40530 Lip excision Medicare reimbursement rates in Arizona
Reports full-thickness removal of lip tissue with free-flap reconstruction, commonly for a lesion or cancer defect requiring tissue transfer. Compare 40530 office and facility rates across CMS payment localities in Arizona.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 40530 in Arizona?
Arizona has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$550.62
1 of 1 localities have a supported rate.
Payment area: Arizona
One mapped payment locality.
Facility setting
$358.04
1 of 1 localities have a supported rate.
Payment area: Arizona
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Plastic surgery
About 40530: Full-thickness lip excision with free-flap reconstruction
Reports full-thickness removal of lip tissue with free-flap reconstruction, commonly for a lesion or cancer defect requiring tissue transfer.
This service removes a full-thickness portion of the lip and reconstructs the defect with a free flap. It may be performed by a plastic surgeon, oral and maxillofacial surgeon, or head and neck surgeon when excision of a lesion, such as a lip cancer, leaves a defect requiring transferred tissue. The operative report should describe the extent of lip removed and the reconstructive method.
Report the code for the combined excision and reconstruction, rather than separately coding routine closure included in that service. 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 multiple procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 40530
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.40 · 32%
- Practice expense (office) RVU10.68 · 63%
- Malpractice RVU0.86 · 5%
136
Medicare services in 2024 · #4628 by national volume
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.
40530 compared with similar codes
Office rates for Arizona, from the same CMS release.
$505.40
40520 includes direct closure after full-thickness excision. 40530 is selected when reconstruction uses a free flap.
No office rate
40525 describes reconstruction with a local flap. 40530 represents reconstruction using a free flap.
No office rate
40527 describes lip reconstruction with a cross-lip flap; 40530 is reported when full-thickness excision is performed with free-flap reconstruction.
Compare 40530 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Arizona →
Office / nonfacility
$550.62
Facility
$358.04
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 40530 in Arizona.
PPRRVU2026_Oct_nonQPP.csv
4,829
- Code
- 40530
- Physician work
- 5.40
- Practice expense
- 10.68
- Malpractice
- 0.86
GPCI2026.csv
6
- Locality
- Arizona
- Physician work
- 1.000
- Practice expense
- 0.969
- Malpractice
- 0.856
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.40 | × 1.000 | 5.4000 |
| Practice expense | 10.68 | × 0.969 | 10.3489 |
| Malpractice | 0.86 | × 0.856 | 0.7362 |
| Total RVUs | 16.4851 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Arizona$550.62
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.4 | 1 |
| Practice expense | 10.68 | 0.969 |
| Malpractice | 0.86 | 0.856 |
(5.4 × 1 + 10.68 × 0.969 + 0.86 × 0.856) × $33.4009 = $550.62
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.4 | 1 |
| Practice expense | 4.73 | 0.969 |
| Malpractice | 0.86 | 0.856 |
(5.4 × 1 + 4.73 × 0.969 + 0.86 × 0.856) × $33.4009 = $358.04
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
40530 billing questions
How does this differ from 40510?
40510 describes full-thickness lip excision that does not require reconstruction. Use 40530 when the excision is accompanied by the free-flap reconstruction represented by this code.
Can the reconstruction be billed separately?
The code represents the excision with its specified free-flap reconstruction. Do not separately report routine reconstructive work that is included in that service.
Should modifier 50 be appended for both sides of the lip?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What documentation supports reporting this code?
Document the full-thickness lip tissue removed, the defect created, and the free-flap reconstruction performed. The operative report should make clear that the service included both excision and reconstruction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,82640525,,Reconstruct lip with flap,A,,7.53,6.18,NA,6.18,,1.20,14.91,14.91,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,82740527,,Reconstruct lip with flap,A,,9.09,6.16,NA,6.16,,1.32,16.57,16.57,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8284052F,,Hemodialysis via av fistula,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,82940530,,Partial removal of lip,A,,5.40,10.68,,4.73,,0.86,16.94,10.99,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8304053F,,Hemodialysis via av graft,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8314054F,,Hemodialysis via catheter,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8324055F,,Pt rcvng periton dialysis,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609
901112,CA,55,CHICO,1.017,1.096,0.536