Billing code 40520: Lip excisionMedicare rate & RVUs in Oregon
Reports full-thickness removal of lip tissue when the resulting defect is reconstructed with a local flap, such as for an excised lip lesion.
Medicare pays $510.88–$553.39 for 40520 in the office in Oregon, from Rest Of Oregon to Portland. 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 40520 covers
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.
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.
Where 40520 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $553.39 | $339.65 |
| Rest Of Oregon | $510.88 | $319.26 |
How the 40520 rate is calculated
Each of 40520’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 · 40520
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.67Practice expense 10.16Malpractice 0.72
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 40520
40520 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40520
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 · 40520
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
40520 without 51 · national office
$519.38
Lip excision
40520-51 · Second procedure: 50%
$259.69
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%).
40520 compared with similar codes
Compare codes
40520 vs 40500 vs 40527 vs 40530: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 40500Lip excision
- 40500 describes a vermilionectomy with mucosal advancement. Choose 40520 for full-thickness excision requiring local-flap reconstruction.
- 40527Lip reconstruction
- 40527 is associated with free-flap reconstruction. 40520 is for reconstruction with a local flap.
- 40530Lip excision
- 40530 describes full-thickness lip excision without reconstruction. Report 40520 when a local flap reconstructs the defect.
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 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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