No office rate
Use 40700 for primary unilateral repair of the cleft deformity. Use 40720 for secondary revision in an adolescent or adult after an earlier repair.
On this page
CMS RVU26D · Effective 2026-10-01
40720 Cleft repair Medicare reimbursement rates in California
Revision surgery for residual cleft-related lip or nasal deformity in an adolescent or adult after an earlier cleft repair. Compare 40720 office and facility rates across CMS payment localities in California.
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 40720 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$923.29–$1090.37
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $167.08 per service.
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.
Where 40720 pays more and less in California
Plastic surgery
About 40720: Secondary cleft lip and nasal revision
Revision surgery for residual cleft-related lip or nasal deformity in an adolescent or adult after an earlier cleft repair.
This service addresses a residual or recurrent lip or nasal deformity after prior cleft repair in an adolescent or adult. A plastic, craniofacial, or facial plastic surgeon may revise features such as lip asymmetry, scar contour, or cleft-related nasal asymmetry. The operative work is tailored to the deformity and is generally performed in a surgical setting; it is a secondary correction rather than the initial cleft repair.
Select the code when the record supports a secondary revision in an adolescent or adult, and document the prior repair, current deformity, patient age, and operative work. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 40720
- 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 procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.35 · 52%
- Practice expense (office) RVU10.60 · 38%
- Malpractice RVU2.67 · 10%
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.
40720 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
Code 40701 describes primary bilateral repair. Code 40720 describes secondary revision in an adolescent or adult.
No office rate
Code 40702 is the secondary repair code for childhood. Code 40720 is for secondary revision in adolescence or adulthood.
Compare 40720 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.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $930.76 |
| Chico | Office Unavailable | Facility $923.29 |
| El Centro | Office Unavailable | Facility $923.74 |
| Fresno | Office Unavailable | Facility $923.29 |
| Hanford-Corcoran | Office Unavailable | Facility $923.29 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $977.01 |
| Madera | Office Unavailable | Facility $923.29 |
| Merced | Office Unavailable | Facility $923.29 |
| Modesto | Office Unavailable | Facility $923.29 |
| Napa | Office Unavailable | Facility $1021.44 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $966.77 |
| Redding | Office Unavailable | Facility $923.29 |
| Rest Of California | Office Unavailable | Facility $923.29 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $952.04 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $956.12 |
| Salinas | Office Unavailable | Facility $952.31 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $965.46 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1064.98 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1061.95 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1090.37 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1077.97 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $938.51 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $967.34 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $953.35 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $976.26 |
| Stockton | Office Unavailable | Facility $923.29 |
| Vallejo | Office Unavailable | Facility $1017.07 |
| Visalia | Office Unavailable | Facility $923.29 |
| Yuba City | Office Unavailable | Facility $923.29 |
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.
40720 billing questions
How does this differ from a primary cleft repair?
This code is for secondary correction in an adolescent or adult after an earlier cleft repair. Codes 40700 and 40701 describe primary repair.
What documentation supports reporting 40720?
Document the patient's age, the prior cleft repair, the residual lip or nasal deformity, and the revision performed.
How is bilateral surgery reported?
When the service is bilateral, report modifier 50; CMS pays the bilateral procedure at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. 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 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.
4,84740701,,Repair cleft lip/nasal,A,,16.80,11.98,NA,11.98,,3.11,31.89,31.89,0,090,0.09,0.81,0.10,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,84840702,,Repair cleft lip/nasal,A,,13.91,10.44,NA,10.44,,2.58,26.93,26.93,0,090,0.09,0.81,0.10,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8494070F,,Dvt prophylx recvd day 2,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
4,85040720,,Repair cleft lip/nasal,A,,14.35,10.60,NA,10.60,,2.67,27.62,27.62,0,090,0.09,0.81,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8514073F,,Oral antiplat thx rx dischrg,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
4,8524075F,,Anticoag thx rx at dischrg,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
4,85340761,,Repair cleft lip/nasal,A,,15.44,10.51,NA,10.51,,2.87,28.82,28.82,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00