No office rate
40700 is for a primary unilateral repair. Choose 40701 when the initial repair addresses both sides.
On this page
CMS RVU26D · Effective 2026-10-01
40701 Cleft lip repair Medicare reimbursement rates in Pennsylvania
Reports initial surgical repair of a bilateral cleft lip with associated nasal deformity, typically performed by a plastic or craniofacial surgeon. Compare 40701 office and facility rates across CMS payment localities in Pennsylvania.
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 40701 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1026.63–$1111.71
2 of 2 localities have a supported rate.
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.
Craniofacial surgery
About 40701: Primary bilateral cleft lip repair
Reports initial surgical repair of a bilateral cleft lip with associated nasal deformity, typically performed by a plastic or craniofacial surgeon.
This code describes the initial operative reconstruction of a cleft involving both sides of the lip, with repair of the associated nasal deformity. It is typically performed by a plastic, craniofacial, or oral and maxillofacial surgeon in an operating room, often as part of an infant’s cleft-care plan. The work addresses the bilateral defect in the same operation rather than a later revision of a prior repair.
Report the code when the operative record supports a primary repair and bilateral involvement; document the defect and the reconstruction performed. The code is priced as bilateral, so modifier 50 does not increase payment. It has a 90-day global period that includes the day-before preoperative visit and related postoperative care during that period. 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. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 40701
- 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
- The code is already priced as bilateral; modifier 50 does not increase payment.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU16.80 · 53%
- Practice expense (office) RVU11.98 · 38%
- Malpractice RVU3.11 · 10%
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.
40701 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
40702 describes a secondary unilateral repair; 40701 is for the initial bilateral repair.
No office rate
40720 is for secondary bilateral repair, while 40701 describes the primary bilateral operation.
No office rate
40761 describes a secondary major revision. It is not the code for an initial bilateral repair.
Compare 40701 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$1111.71
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$1026.63
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40701 billing questions
When should 40701 be selected instead of 40700?
Use 40701 for a primary repair involving both sides. Code 40700 describes a primary unilateral repair.
Should modifier 50 be appended for bilateral repair?
The code is already priced as bilateral, and modifier 50 does not increase payment.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure reduction.
Can an assistant surgeon be reported?
CMS permits payment for an assistant at surgery. Co-surgeons and team surgery are not permitted for this code.
What documentation supports primary bilateral repair?
The operative report should establish that this is the initial repair, describe the bilateral cleft and associated nasal deformity, and document the reconstruction 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 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.
4,8444067F,,Pt referral for ect docd,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
4,8454069F,,Vte prophylaxis rcvd,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
4,84640700,,Repair cleft lip/nasal,A,,13.82,10.90,NA,10.90,,2.57,27.29,27.29,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,84740701,,Repair cleft lip/nasal,A,,16.80,11.98,NA,11.98,,3.11,31.89,31.89,0,090,0.09,0.81,0.10,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,84840702,,Repair cleft lip/nasal,A,,13.91,10.44,NA,10.44,,2.58,26.93,26.93,0,090,0.09,0.81,0.10,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8494070F,,Dvt prophylx recvd day 2,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
4,85040720,,Repair cleft lip/nasal,A,,14.35,10.60,NA,10.60,,2.67,27.62,27.62,0,090,0.09,0.81,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00