Billing code 40654: Lip repairMedicare rate & RVUs in Florida
Repair a complex, full-thickness lip injury extending over half the lip’s vertical height, such as a deep traumatic laceration requiring extensive reconstruction.
Medicare pays $613.01–$677.29 for 40654 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 9 sections
What 40654 covers
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.
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 40654 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$613.01 to $677.29
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $645.11 | $420.79 |
| Miami | $677.29 | $446.76 |
| Rest Of Florida | $613.01 | $401.31 |
How the 40654 rate is calculated
Each of 40654’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 · 40654
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.34Practice expense 12.26Malpractice 0.86
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 40654
40654 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40654
Lip repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 40654
Lip 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
40654 without 51 · national office
$616.58
Lip repair
40654-51 · Second procedure: 50%
$308.29
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%).
40654 compared with similar codes
Compare codes
40654 vs 40650 vs 40652 vs 12011 vs 13151: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 40650Lip repair
- 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.
- 40652Lip repair
- 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.
- 12011Wound repair
- 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.
- 13151Complex repair
- 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.
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 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
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