Billing code 40700: Cleft lip repairMedicare rate & RVUs in Oklahoma
Reports initial surgical reconstruction of one side of a cleft lip, including associated nasal deformity repair, for partial or complete clefts.
CMS doesn’t publish an office rate for 40700 in Oklahoma.
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 40700 covers
This code represents the initial reconstruction of one side of a cleft lip, with associated nasal deformity addressed as part of the repair. The surgeon restores the continuity and shape of the upper lip and may correct related nasal asymmetry during the same operation. A plastic or craniofacial surgeon typically performs the procedure in an operating room as part of congenital cleft care.
Select the code for a primary unilateral repair, whether the cleft is partial or complete; documentation should establish laterality, that the repair is primary, and the lip and nasal work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented 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.
40700 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | Unavailable | $853.41 |
How the 40700 rate is calculated
Each of 40700’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 · 40700
RVUs × geographic indexes × conversion factor
Work13.82
13.82 RVUs× 1.000 GPCI
Practice expense10.90
10.90 RVUs× 1.000 GPCI
Malpractice2.57
2.57 RVUs× 1.000 GPCI
Adjusted RVUs
27.2900
Conversion factor
$33.4009
Medicare rate
$911.51
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40700
40700 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40700
Cleft 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 · 40700
Cleft 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
40700 without 51 · national facility
$911.51
Cleft lip repair
40700-51 · Second procedure: 50%
$455.76
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%).
40700 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 40701Cleft lip repair
- 40700 is for a primary repair on one side; 40701 describes primary repair of a bilateral cleft.
- 40702Cleft lip repair
- 40700 is the initial repair. 40702 describes a secondary operation that recreates the defect before closure.
- 40720Cleft repair
- Use 40720 for an intermediate secondary repair, not the initial unilateral repair reported with 40700.
- 40761Cleft repair
- 40761 describes extensive secondary repair requiring osteotomies; 40700 is for primary unilateral repair.
40700 billing questions
When is 40700 selected instead of a secondary-repair code?
Use 40700 for the initial repair on one side, including a partial or complete cleft. Codes for secondary repair apply when the operation revises a previously repaired cleft.
Can modifier 50 be used for bilateral cleft lip repair?
No. CMS identifies bilateral adjustment as inappropriate for 40700; this code represents unilateral repair.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other same-session procedures paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and additional procedures are paid at 50%.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What should the operative report establish?
Document that the repair is primary and unilateral, whether the cleft is partial or complete, and the lip and associated nasal work performed.
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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