$596.04
Use 40650 for a full-thickness lip repair confined to the vermilion; 40654 describes a more extensive, complex injury extending over half the lip’s vertical height.
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CMS RVU26D · Effective 2026-10-01
40654 Lip repair Medicare reimbursement rates in Colorado
Repair a complex, full-thickness lip injury extending over half the lip’s vertical height, such as a deep traumatic laceration requiring extensive reconstruction. Compare 40654 office and facility rates across CMS payment localities in Colorado.
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 40654 in Colorado?
Colorado 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
$638.64
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
$403.02
1 of 1 localities have a supported rate.
Payment area: Colorado
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.
Surgical repair
About 40654: Extensive complex full-thickness lip repair
Repair a complex, full-thickness lip injury extending over half the lip’s vertical height, such as a deep traumatic laceration requiring extensive reconstruction.
This service repairs a deep injury that passes through the lip and extends over half its vertical height. It is commonly performed for significant traumatic lacerations involving the skin, muscle, and inner lip, including injuries where careful restoration of the lip’s shape and border is needed. Plastic surgeons, otolaryngologists, oral and maxillofacial surgeons, and emergency physicians may perform the repair in hospital or outpatient settings.
Select this code based on full-thickness involvement, the extent measured against vertical lip height, and the complexity of the repair—not wound length alone. Document the involved lip, depth, vertical extent, and repair performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, and co-surgeons and team surgery are not permitted.
CMS billing rules for 40654
- 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 RVU5.34 · 29%
- Practice expense (office) RVU12.26 · 66%
- Malpractice RVU0.86 · 5%
603
Medicare services in 2024 · #3392 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.
40654 compared with similar codes
Office rates for Colorado, from the same CMS release.
$594.23
40652 applies to full-thickness injuries extending up to half the lip’s vertical height. Choose 40654 when the injury extends over half and the repair is complex.
$144.57
12011 is for a qualifying simple repair of a superficial facial wound. It does not describe the extensive, full-thickness lip repair represented by 40654.
$433.94
13151 describes complex repair of specified facial sites, including the lip, based on wound length. 40654 is specific to a complex full-thickness lip injury extending over half its vertical height.
Compare 40654 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
Colorado →
Office / nonfacility
$638.64
Facility
$403.02
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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 40654 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
4,841
- Code
- 40654
- Physician work
- 5.34
- Practice expense
- 12.26
- Malpractice
- 0.86
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.34 | × 1.012 | 5.4041 |
| Practice expense | 12.26 | × 1.064 | 13.0446 |
| Malpractice | 0.86 | × 0.781 | 0.6717 |
| Total RVUs | 19.1204 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$638.64
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.34 | 1.012 |
| Practice expense | 12.26 | 1.064 |
| Malpractice | 0.86 | 0.781 |
(5.34 × 1.012 + 12.26 × 1.064 + 0.86 × 0.781) × $33.4009 = $638.64
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.34 | 1.012 |
| Practice expense | 5.63 | 1.064 |
| Malpractice | 0.86 | 0.781 |
(5.34 × 1.012 + 5.63 × 1.064 + 0.86 × 0.781) × $33.4009 = $403.02
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.
40654 billing questions
How is 40654 distinguished from 40652?
40654 is for a complex, full-thickness injury extending over half the lip’s vertical height. 40652 is for a full-thickness injury extending up to half that height.
What should the repair note document?
Document full-thickness involvement, the injured lip, the wound’s extent relative to vertical lip height, and the repair performed. These details support selection over the lesser-extent lip repair codes.
Should modifier 50 be used for injuries involving both sides of the mouth?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How does the 90-day global period affect follow-up?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant, co-surgeon, or surgical team be reported?
Assistant-at-surgery payment is statutorily restricted. Co-surgeons and team surgery are not permitted for this code.
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.
4,8384064F,,Antidepressant rx,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
4,83940650,,Rpr lip fth vermilion only,A,,3.69,12.66,,5.96,,0.82,17.17,10.47,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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4,8424065F,,Antipsychotic rx,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
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4,8444067F,,Pt referral for ect docd,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
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899