No office rate
Use 40527 when tissue is transferred from the opposite lip as a cross-lip flap. Use 40525 when the documented reconstruction uses another local flap.
On this page
CMS RVU26D · Effective 2026-10-01
40527 Lip reconstruction Medicare reimbursement rates in Connecticut
Reconstructs a full-thickness lip defect by transferring tissue from the opposite lip, typically when primary closure or a local flap is unsuitable. Compare 40527 office and facility rates across CMS payment localities in Connecticut.
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 40527 in Connecticut?
Connecticut 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
No supported rate
Facility setting
$584.63
1 of 1 localities have a supported rate.
Payment area: Connecticut
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 40527: Full-thickness lip reconstruction with cross-lip flap
Reconstructs a full-thickness lip defect by transferring tissue from the opposite lip, typically when primary closure or a local flap is unsuitable.
This procedure rebuilds a full-thickness defect of the upper or lower lip using a flap of tissue transferred from the opposite lip. The flap remains attached to its donor site initially, creating a temporary connection between the lips. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons may use this approach for defects after tumor removal or trauma when local tissue cannot provide adequate reconstruction. The service is generally performed in a facility setting.
Report the code when the operative documentation supports reconstruction with a cross-lip flap, rather than a different flap or graft method. Document the defect, donor and recipient sites, and the flap technique. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and the others are subject to the standard reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 40527
- 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
- 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 RVU9.09 · 55%
- Practice expense (office) RVU6.16 · 37%
- Malpractice RVU1.32 · 8%
41
Medicare services in 2024 · #5484 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.
40527 compared with similar codes
Office rates for Connecticut, from the same CMS release.
$602.92
40530 describes lip excision with reconstruction by graft; 40527 is for reconstruction with a cross-lip flap.
$530.83
40510 involves lip excision with local-flap reconstruction. 40527 identifies the distinct cross-lip flap technique.
Compare 40527 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
Connecticut →
Office / nonfacility
Unavailable
Facility
$584.63
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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 40527 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
4,827
- Code
- 40527
- Physician work
- 9.09
- Practice expense
- 6.16
- Malpractice
- 1.32
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.09 | × 1.020 | 9.2718 |
| Practice expense | 6.16 | × 1.077 | 6.6343 |
| Malpractice | 1.32 | × 1.210 | 1.5972 |
| Total RVUs | 17.5033 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$584.63
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.09 | 1.02 |
| Practice expense | 6.16 | 1.077 |
| Malpractice | 1.32 | 1.21 |
(9.09 × 1.02 + 6.16 × 1.077 + 1.32 × 1.21) × $33.4009 = $584.63
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.
40527 billing questions
How does this differ from 40525?
40527 is for reconstruction using a cross-lip flap, which transfers tissue from the opposite lip. Choose 40525 when the documented reconstruction uses a different local flap technique.
Is the flap reported separately?
The cross-lip flap is the reconstructive method represented by 40527. Do not report a separate flap service for the same reconstruction.
Should modifier 50 be used when both lips are involved?
No. Modifier 50 is inappropriate for this code; document the cross-lip reconstruction and the donor and recipient sites.
When is an assistant surgeon payable?
Assistant-at-surgery payment is allowed only when the record documents medical necessity. Co-surgeons and team surgery are not permitted for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
4,8244051F,,Referred for an 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
4,82540520,,Partial excision of lip,A,,4.67,10.16,,4.40,,0.72,15.55,9.79,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,82640525,,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
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808