Billing code 40530: Lip excisionMedicare rate & RVUs in Ohio
Reports full-thickness removal of lip tissue with free-flap reconstruction, commonly for a lesion or cancer defect requiring tissue transfer.
Medicare pays $535.01 for 40530 in the office in Ohio (Ohio). 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 40530 covers
This service removes a full-thickness portion of the lip and reconstructs the defect with a free flap. It may be performed by a plastic surgeon, oral and maxillofacial surgeon, or head and neck surgeon when excision of a lesion, such as a lip cancer, leaves a defect requiring transferred tissue. The operative report should describe the extent of lip removed and the reconstructive method.
Report the code for the combined excision and reconstruction, rather than separately coding routine closure included in that service. 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 multiple procedure 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.
40530 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $535.01 | $353.56 |
How the 40530 rate is calculated
Each of 40530’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 · 40530
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.40Practice expense 10.68Malpractice 0.86
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 40530
40530 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40530
Lip excision
| 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 · 40530
Lip excision
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
40530 without 51 · national office
$565.81
Lip excision
40530-51 · Second procedure: 50%
$282.91
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%).
40530 compared with similar codes
Compare codes
40530 vs 40510 vs 40520 vs 40525 vs 40527: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 40510Lip excision
- 40510 is for full-thickness excision that does not require reconstruction. 40530 includes free-flap reconstruction of the excision defect.
- 40520Lip excision
- 40520 includes direct closure after full-thickness excision. 40530 is selected when reconstruction uses a free flap.
- 40525Lip reconstruction
- 40525 describes reconstruction with a local flap. 40530 represents reconstruction using a free flap.
- 40527Lip reconstruction
- 40527 describes lip reconstruction with a cross-lip flap; 40530 is reported when full-thickness excision is performed with free-flap reconstruction.
40530 billing questions
How does this differ from 40510?
40510 describes full-thickness lip excision that does not require reconstruction. Use 40530 when the excision is accompanied by the free-flap reconstruction represented by this code.
Can the reconstruction be billed separately?
The code represents the excision with its specified free-flap reconstruction. Do not separately report routine reconstructive work that is included in that service.
Should modifier 50 be appended for both sides of the lip?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What documentation supports reporting this code?
Document the full-thickness lip tissue removed, the defect created, and the free-flap reconstruction performed. The operative report should make clear that the service included both excision and reconstruction.
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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