$616.25
40650 is confined to the vermilion. Consider 40652 when the full-thickness wound extends farther into the lip and its vertical extent supports that level.
On this page
CMS RVU26D · Effective 2026-10-01
40650 Lip repair Medicare reimbursement rates in Hawaii
Reports repair of a full-thickness lip wound confined to the vermilion, with careful alignment of the lip edge after injury. Compare 40650 office and facility rates across CMS payment localities in Hawaii.
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 40650 in Hawaii?
Hawaii 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
$619.89
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$365.45
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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 40650: Full-thickness vermilion lip repair
Reports repair of a full-thickness lip wound confined to the vermilion, with careful alignment of the lip edge after injury.
This service repairs a wound that passes through the lip but is confined to the vermilion portion. The repair restores the tissue layers and carefully aligns the vermilion edge, where even a small step-off can be visible. Plastic surgeons, facial plastic surgeons, oral and maxillofacial surgeons, otolaryngologists, and emergency physicians may perform it, commonly for traumatic lip lacerations in an emergency department or operating room.
Select this code when the documented full-thickness injury is limited to the vermilion; a wound extending farther into the lip may fit another level in the repair family based on its extent or complexity. The note should establish wound depth and location and describe the repair. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 40650
- 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 RVU3.69 · 21%
- Practice expense (office) RVU12.66 · 74%
- Malpractice RVU0.82 · 5%
485
Medicare services in 2024 · #3594 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.
40650 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$660.59
Use 40654 for a full-thickness repair involving greater vertical extent or complexity; 40650 is limited to vermilion-only repair.
$149.70
12011 is for a simple, superficial facial wound within its length range. A full-thickness lip wound confined to the vermilion calls for 40650 instead.
Compare 40650 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
Hawaii, Guam →
Office / nonfacility
$619.89
Facility
$365.45
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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 40650 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
4,839
- Code
- 40650
- Physician work
- 3.69
- Practice expense
- 12.66
- Malpractice
- 0.82
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.69 | × 1.000 | 3.6900 |
| Practice expense | 12.66 | × 1.137 | 14.3944 |
| Malpractice | 0.82 | × 0.579 | 0.4748 |
| Total RVUs | 18.5592 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$619.89
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.69 | 1 |
| Practice expense | 12.66 | 1.137 |
| Malpractice | 0.82 | 0.579 |
(3.69 × 1 + 12.66 × 1.137 + 0.82 × 0.579) × $33.4009 = $619.89
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.69 | 1 |
| Practice expense | 5.96 | 1.137 |
| Malpractice | 0.82 | 0.579 |
(3.69 × 1 + 5.96 × 1.137 + 0.82 × 0.579) × $33.4009 = $365.45
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.
40650 billing questions
How is this distinguished from 40652?
Use 40650 when the full-thickness repair is confined to the vermilion. A wound extending beyond that area should be evaluated for the appropriate sibling level based on extent.
When would 40654 be considered instead?
Consider 40654 when the repair involves more than half the lip’s vertical height or is complex. The operative note should support the extent or complexity.
Can the closure layers or sutures be billed separately?
The code represents the lip repair; do not report each closure layer, suture, or stitch as a separate procedure.
Is modifier 50 appropriate?
No. CMS identifies modifier 50 as inappropriate for this code based on the descriptor or anatomy.
What documentation supports reporting this code?
Document that the wound is full thickness and confined to the vermilion, along with its location and the repair performed. Record any extension beyond the vermilion that could support a different family level.
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.
4,8364062F,,Pt referral psych 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
4,8374063F,,Antidepres rxthxpy not rxd,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
4,8384064F,,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
4,84040652,,Rpr lip fth<half ver height,A,,4.32,12.01,,5.70,,0.82,17.15,10.84,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,84140654,,Rpr lip fth>1half ver ht/cpx,A,,5.34,12.26,,5.63,,0.86,18.46,11.83,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8424065F,,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
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014