Billing code 40652: Lip repairMedicare rate & RVUs in Iowa
Repair a full-thickness lip injury extending through the lip but involving less than half its vertical height, with extent and tissue involvement documented.
Medicare pays $522.21 for 40652 in the office in Iowa (Iowa). Which amount applies depends on the service address.
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 40652 covers
This code describes repair of a full-thickness lip injury that extends through the lip but involves less than half its vertical height. The injury may involve the external skin, lip muscle, and inner oral lining. A physician or other qualified surgeon typically performs the repair in an emergency department, operating room, or other setting where the injury is treated. Precise alignment of the lip edges, including the vermilion border when involved, helps restore the lip’s contour.
Choose the code based on the injury’s depth and vertical extent, and document the involved layers and proportion of lip height affected. CMS assigns a 90-day global period, including 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 the others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; 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.
40652 in Iowa
| Payment locality | Office | Facility |
|---|---|---|
| Iowa | $522.21 | $329.37 |
How the 40652 rate is calculated
Each of 40652’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 · 40652
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.32Practice expense 12.01Malpractice 0.82
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 40652
40652 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40652
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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| 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 · 40652
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
40652 without 51 · national office
$572.83
Lip repair
40652-51 · Second procedure: 50%
$286.42
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%).
40652 compared with similar codes
Compare codes
40652 vs 40650 vs 40654 vs 12011: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 40650Lip repair
- Choose 40650 when the full-thickness repair is limited to the vermilion. This code describes a full-thickness injury involving less than half the lip’s vertical height.
- 40654Lip repair
- Choose 40654 when the full-thickness repair involves more than half the lip’s vertical height or is complex; this code is for the less-than-half-height repair.
- 12011Wound repair
- 12011 describes repair of qualifying superficial facial wounds, including lip wounds. It is not the choice for a full-thickness injury extending through the lip.
40652 billing questions
How does this differ from 40650?
40652 is for a full-thickness injury involving less than half the lip’s vertical height. 40650 is for a full-thickness repair limited to the vermilion.
When is 40654 the better choice?
Use 40654 for a full-thickness repair involving more than half the lip’s vertical height or a complex repair. Document the extent and complexity supporting that selection.
What should the operative note document?
Document that the injury is full thickness, the lip layers involved, and how much of the lip’s vertical height is affected. Include the repair details and any complexity relevant to code selection.
Can modifier 50 be used for a repair on both sides?
No. CMS identifies modifier 50 as inappropriate for this code because of its descriptor or anatomy.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be paid?
CMS assistant-at-surgery payment is allowed only when medical necessity is documented. 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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