Billing code 40525: Lip reconstructionMedicare rate & RVUs in Illinois
Report 40525 for full-thickness lip reconstruction using a local flap to restore tissue after a defect from surgery, trauma, or a congenital condition.
CMS doesn’t publish an office rate for 40525 in Illinois.
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 40525 covers
This service reconstructs a full-thickness lip defect by moving nearby tissue on a local flap to restore the lip’s contour and continuity. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons may perform it after tumor removal, traumatic injury, or repair of a congenital defect. The reconstruction may involve the lip’s skin, muscle, and mucosal lining, depending on the defect.
Report 40525 when the operative work is full-thickness reconstruction with a local flap, rather than a cross-lip flap or an excision service alone. The operative report should identify the defect and its cause, the full-thickness involvement, the flap used, and how the tissue was transferred and inset. This major surgery includes the day-before preoperative visit and 90 days of related postoperative care. 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 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; 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 40525 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $552.71 |
| East St. Louis | Unavailable | $522.14 |
| Rest Of Illinois | Unavailable | $502.61 |
| Suburban Chicago | Unavailable | $536.28 |
How the 40525 rate is calculated
Each of 40525’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 · 40525
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.53Practice expense 6.18Malpractice 1.20
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 40525
40525 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40525
Lip reconstruction
| 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 · 40525
Lip reconstruction
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
40525 without 51 · national facility
$498.01
Lip reconstruction
40525-51 · Second procedure: 50%
$249.01
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%).
40525 compared with similar codes
Compare codes
40525 vs 40527 vs 40510 vs 40520: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 40527Lip reconstruction
- Choose 40527 when the full-thickness reconstruction uses a cross-lip flap. 40525 describes reconstruction with a local flap.
- 40510Lip excision
- 40510 describes an excision service. Use 40525 when the reported work is reconstruction of a full-thickness lip defect with a local flap.
- 40520Lip excision
- 40520 is an excision-oriented lip procedure; 40525 is for full-thickness reconstruction using a local flap.
40525 billing questions
How does 40525 differ from 40527?
40525 is for full-thickness reconstruction using a local flap. 40527 is the related code for reconstruction with a cross-lip flap.
Can 40525 be reported with the procedure that created the lip defect?
When reconstruction and another procedure are performed in the same session, report the services supported by the operative work. The standard multiple procedure reduction applies to other procedures in that session.
What documentation supports 40525?
Document the full-thickness defect, its cause and extent, the local flap used, and the tissue transfer and inset performed.
Should modifier 50 be used for a lip defect involving both sides?
No. The CMS bilateral adjustment does not apply to 40525, and modifier 50 is inappropriate.
Is an assistant surgeon separately payable for 40525?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are also not permitted.
Does 40525 include postoperative visits?
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 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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