Billing code 40701: Cleft lip repairMedicare rate & RVUs in Guam
Reports initial surgical repair of a bilateral cleft lip with associated nasal deformity, typically performed by a plastic or craniofacial surgeon.
CMS doesn’t publish an office rate for 40701 in Guam.
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 40701 covers
This code describes the initial operative reconstruction of a cleft involving both sides of the lip, with repair of the associated nasal deformity. It is typically performed by a plastic, craniofacial, or oral and maxillofacial surgeon in an operating room, often as part of an infant’s cleft-care plan. The work addresses the bilateral defect in the same operation rather than a later revision of a prior repair.
Report the code when the operative record supports a primary repair and bilateral involvement; document the defect and the reconstruction performed. The code is priced as bilateral, so modifier 50 does not increase payment. It has a 90-day global period that includes the day-before preoperative visit and related postoperative care during that period. 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. An assistant at surgery may be paid; 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.
40701 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,076.24 |
How the 40701 rate is calculated
Each of 40701’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 · 40701
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 16.80Practice expense 11.98Malpractice 3.11
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 40701
40701 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40701
Cleft 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) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| 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 · 40701
Cleft 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
40701 without 51 · national facility
$1,065.15
Cleft lip repair
40701-51 · Second procedure: 50%
$532.58
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%).
40701 compared with similar codes
Compare codes
40701 vs 40700 vs 40702 vs 40720 vs 40761: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 40700Cleft lip repair
- 40700 is for a primary unilateral repair. Choose 40701 when the initial repair addresses both sides.
- 40702Cleft lip repair
- 40702 describes a secondary unilateral repair; 40701 is for the initial bilateral repair.
- 40720Cleft repair
- 40720 is for secondary bilateral repair, while 40701 describes the primary bilateral operation.
- 40761Cleft repair
- 40761 describes a secondary major revision. It is not the code for an initial bilateral repair.
40701 billing questions
When should 40701 be selected instead of 40700?
Use 40701 for a primary repair involving both sides. Code 40700 describes a primary unilateral repair.
Should modifier 50 be appended for bilateral repair?
The code is already priced as bilateral, and modifier 50 does not increase payment.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure reduction.
Can an assistant surgeon be reported?
CMS permits payment for an assistant at surgery. Co-surgeons and team surgery are not permitted for this code.
What documentation supports primary bilateral repair?
The operative report should establish that this is the initial repair, describe the bilateral cleft and associated nasal deformity, and document the reconstruction performed.
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
Fee sheets
Put 40701 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →