$461.05
40500 represents full-thickness lip excision with primary closure. Use 40510 when the operative report supports its distinct excision and closure approach.
On this page
CMS RVU26D · Effective 2026-10-01
40500 Lip excision Medicare reimbursement rates in Kentucky
Reports removal of a full-thickness portion of the lip followed by direct closure, such as for a localized lesion requiring excision. Compare 40500 office and facility rates across CMS payment localities in Kentucky.
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 40500 in Kentucky?
Kentucky 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
$485.82
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$312.70
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 40500: Full-thickness lip excision with primary closure
Reports removal of a full-thickness portion of the lip followed by direct closure, such as for a localized lesion requiring excision.
This service removes a full-thickness segment of the upper or lower lip and closes the resulting defect primarily, without using a flap for reconstruction. It may be performed for a localized lip lesion or neoplasm when the required excision extends through the lip. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons may perform the operation in an operating room or an appropriately equipped outpatient surgical setting.
Choose this code when the operative report supports full-thickness excision and direct closure; document the site, extent of tissue removed, indication, and closure method. The 90-day global period 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% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 40500
- 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 RVU4.36 · 28%
- Practice expense (office) RVU10.87 · 69%
- Malpractice RVU0.57 · 4%
119
Medicare services in 2024 · #4748 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.
40500 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$479.67
Both are lip excision codes, but 40500 is for direct primary closure; 40520 reflects a different operative approach.
No office rate
40500 describes excision followed by primary closure. 40525 is a reconstruction code for a defect requiring a reconstructive approach.
Compare 40500 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
Kentucky →
Office / nonfacility
$485.82
Facility
$312.70
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 40500 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
4,821
- Code
- 40500
- Physician work
- 4.36
- Practice expense
- 10.87
- Malpractice
- 0.57
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.36 | × 1.000 | 4.3600 |
| Practice expense | 10.87 | × 0.889 | 9.6634 |
| Malpractice | 0.57 | × 0.915 | 0.5215 |
| Total RVUs | 14.5450 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$485.82
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.36 | 1 |
| Practice expense | 10.87 | 0.889 |
| Malpractice | 0.57 | 0.915 |
(4.36 × 1 + 10.87 × 0.889 + 0.57 × 0.915) × $33.4009 = $485.82
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.36 | 1 |
| Practice expense | 5.04 | 0.889 |
| Malpractice | 0.57 | 0.915 |
(4.36 × 1 + 5.04 × 0.889 + 0.57 × 0.915) × $33.4009 = $312.70
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.
40500 billing questions
How does 40500 differ from other lip excision codes?
Use 40500 for a full-thickness lip excision closed primarily. Select a neighboring excision code when the documented operative technique or reconstruction differs.
What operative details support 40500?
Document the lip site, full-thickness extent of the excision, clinical indication, and that the defect was closed directly rather than reconstructed with a flap.
Can modifier 50 be used for excisions on both sides of the lip?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.
Can an assistant or co-surgeon be reported for 40500?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What postoperative care is included?
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 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.
4,8184048F,,Doc antibio given b/4 surg,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
4,81940490,,Biopsy of lip,A,,1.19,2.29,,0.37,,0.12,3.60,1.68,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8204049F,,Doc order given stop antibio,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
4,82140500,,Partial excision of lip,A,,4.36,10.87,,5.04,,0.57,15.80,9.97,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8224050F,,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
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631