Billing code 40761: Cleft repairMedicare rate & RVUs in Illinois
Reports secondary cleft lip and nasal reconstruction using tissue transferred from the opposite lip, including closure of the flap donor site.
CMS doesn’t publish an office rate for 40761 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 40761 covers
This operation rebuilds a previously repaired cleft lip and associated nasal deformity using a cross-lip flap: tissue from one lip is transferred to restore deficient tissue in the other. The surgeon also closes the flap donor site as part of the service. Plastic surgeons and cleft-craniofacial surgeons typically perform this reconstruction in an operating room when a prior repair leaves a lip or nasal defect that calls for flap tissue rather than direct reclosure.
Select the code when the documented secondary repair uses a cross-lip flap for cleft lip/nasal reconstruction; a routine primary repair or secondary repair by direct recreation and closure is a different service. The operative report should identify the defect, flap design and transfer, repaired lip/nasal structures, and donor-site closure. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant-at-surgery service, 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 40761 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 | $1,092.12 |
| East St. Louis | Unavailable | $1,031.73 |
| Rest Of Illinois | Unavailable | $986.04 |
| Suburban Chicago | Unavailable | $1,049.71 |
How the 40761 rate is calculated
Each of 40761’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 · 40761
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 15.44Practice expense 10.51Malpractice 2.87
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 40761
40761 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40761
Cleft 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 · 40761
Cleft 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
40761 without 51 · national facility
$962.61
Cleft repair
40761-51 · Second procedure: 50%
$481.31
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%).
40761 compared with similar codes
Compare codes
40761 vs 40720 vs 40702 vs 40700: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 40720Cleft repair
- Both describe secondary cross-lip flap reconstruction. 40761 applies when the service includes cleft nasal repair; 40720 is for the corresponding lip repair without nasal repair.
- 40702Cleft lip repair
- Use 40702 for secondary cleft lip repair by recreating and closing the defect. Use 40761 when reconstruction uses a cross-lip flap and includes nasal repair.
- 40700Cleft lip repair
- 40700 is a primary unilateral cleft lip repair. 40761 is secondary reconstruction using a cross-lip flap, with nasal repair included.
40761 billing questions
How is this different from 40720?
40761 is for secondary cleft lip/nasal repair with a cross-lip flap. Use 40720 for the corresponding secondary cross-lip repair when nasal repair is not part of the service.
Can this be reported for a direct revision without a flap?
No. This code describes reconstruction using a cross-lip flap; secondary repair by recreating the defect and closing it is represented by a different code.
Is the flap donor-site closure separately reported?
No. Closure of the donor site is included in this service.
Should modifier 50 be used for bilateral anatomy?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What global care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant-at-surgery service for this code. Co-surgeons and team surgery are not permitted.
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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