$491.44
40500 describes a vermilionectomy with mucosal advancement. Choose 40520 for full-thickness excision requiring local-flap reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
40520 Lip excision Medicare reimbursement rates in Indiana
Reports full-thickness removal of lip tissue when the resulting defect is reconstructed with a local flap, such as for an excised lip lesion. Compare 40520 office and facility rates across CMS payment localities in Indiana.
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 40520 in Indiana?
Indiana 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
$482.25
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$303.91
1 of 1 localities have a supported rate.
Payment area: Indiana
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.
Plastic surgery
About 40520: Full-thickness lip excision with local flap
Reports full-thickness removal of lip tissue when the resulting defect is reconstructed with a local flap, such as for an excised lip lesion.
This operation removes the full thickness of part of the lip and uses nearby lip tissue to reconstruct the defect. It may be performed for a lesion, including a lip cancer, when excision leaves a defect requiring flap repair. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons may perform it in an operating room or another surgical setting appropriate to the procedure.
Report 40520 when the operative record supports full-thickness excision and local-flap reconstruction. Document the lip site, extent of tissue removed, and reconstruction performed; a superficial shave or excision closed without a flap describes a different service. The procedure has a 90-day global period, including the day-before preoperative visit and related postoperative care. When other procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 40520
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.67 · 30%
- Practice expense (office) RVU10.16 · 65%
- Malpractice RVU0.72 · 5%
366
Medicare services in 2024 · #3810 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.
40520 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
40527 is associated with free-flap reconstruction. 40520 is for reconstruction with a local flap.
$525.01
40530 describes full-thickness lip excision without reconstruction. Report 40520 when a local flap reconstructs the defect.
Compare 40520 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
Indiana →
Office / nonfacility
$482.25
Facility
$303.91
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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 40520 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
4,825
- Code
- 40520
- Physician work
- 4.67
- Practice expense
- 10.16
- Malpractice
- 0.72
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.67 | × 1.000 | 4.6700 |
| Practice expense | 10.16 | × 0.927 | 9.4183 |
| Malpractice | 0.72 | × 0.486 | 0.3499 |
| Total RVUs | 14.4382 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$482.25
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.67 | 1 |
| Practice expense | 10.16 | 0.927 |
| Malpractice | 0.72 | 0.486 |
(4.67 × 1 + 10.16 × 0.927 + 0.72 × 0.486) × $33.4009 = $482.25
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.67 | 1 |
| Practice expense | 4.4 | 0.927 |
| Malpractice | 0.72 | 0.486 |
(4.67 × 1 + 4.4 × 0.927 + 0.72 × 0.486) × $33.4009 = $303.91
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.
40520 billing questions
When should 40520 be chosen over a code for lip excision without reconstruction?
Use 40520 when the full-thickness lip defect is reconstructed with a local flap. Excision without reconstruction is represented by a different code, such as 40530.
Does this code include the local-flap repair?
Yes. The service includes local-flap reconstruction of the defect created by the full-thickness lip excision; do not report the included repair again as a separate service.
What operative details support reporting 40520?
Document the lip site, full-thickness extent of the excision, and use of a local flap to reconstruct the defect. The record should make clear that this was more than a superficial shave or primary closure.
Can modifier 50 be reported for excisions on both sides of the lip?
No. Modifier 50 is inappropriate for this code, even when the operative work involves both sides.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The global period follows the operation, not each subsequent visit.
Can an assistant or co-surgeon be billed for this operation?
Medicare does not pay an assistant at surgery for 40520. Co-surgeon and team-surgery billing are also 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 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.
4,8224050F,,Ht care plan doc,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
4,82340510,,Partial excision of lip,A,,4.70,9.53,,4.11,,0.69,14.92,9.50,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8244051F,,Referred for an av fistula,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
4,82540520,,Partial excision of lip,A,,4.67,10.16,,4.40,,0.72,15.55,9.79,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,82640525,,Reconstruct lip with flap,A,,7.53,6.18,NA,6.18,,1.20,14.91,14.91,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,82740527,,Reconstruct lip with flap,A,,9.09,6.16,NA,6.16,,1.32,16.57,16.57,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8284052F,,Hemodialysis via av fistula,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
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915