No office rate
Both describe secondary cross-lip flap reconstruction. 40761 applies when the service includes cleft nasal repair; 40720 is for the corresponding lip repair without nasal repair.
On this page
CMS RVU26D · Effective 2026-10-01
40761 Cleft repair Medicare reimbursement rates in Rhode Island
Reports secondary cleft lip and nasal reconstruction using tissue transferred from the opposite lip, including closure of the flap donor site. Compare 40761 office and facility rates across CMS payment localities in Rhode Island.
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 40761 in Rhode Island?
Rhode Island 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
No supported rate
Facility setting
$973.64
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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 40761: Secondary cleft lip and nasal repair with cross-lip flap
Reports secondary cleft lip and nasal reconstruction using tissue transferred from the opposite lip, including closure of the flap donor site.
This operation rebuilds a previously repaired cleft lip and associated nasal deformity using a cross-lip flap: tissue from one lip is transferred to restore deficient tissue in the other. The surgeon also closes the flap donor site as part of the service. Plastic surgeons and cleft-craniofacial surgeons typically perform this reconstruction in an operating room when a prior repair leaves a lip or nasal defect that calls for flap tissue rather than direct reclosure.
Select the code when the documented secondary repair uses a cross-lip flap for cleft lip/nasal reconstruction; a routine primary repair or secondary repair by direct recreation and closure is a different service. The operative report should identify the defect, flap design and transfer, repaired lip/nasal structures, and donor-site closure. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant-at-surgery service, and co-surgeons and team surgery are not permitted.
CMS billing rules for 40761
- 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 RVU15.44 · 54%
- Practice expense (office) RVU10.51 · 36%
- Malpractice RVU2.87 · 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.
40761 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
Use 40702 for secondary cleft lip repair by recreating and closing the defect. Use 40761 when reconstruction uses a cross-lip flap and includes nasal repair.
No office rate
40700 is a primary unilateral cleft lip repair. 40761 is secondary reconstruction using a cross-lip flap, with nasal repair included.
Compare 40761 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
Rhode Island →
Office / nonfacility
Unavailable
Facility
$973.64
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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 40761 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
4,853
- Code
- 40761
- Physician work
- 15.44
- Practice expense
- 10.51
- Malpractice
- 2.87
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.44 | × 1.019 | 15.7334 |
| Practice expense | 10.51 | × 1.033 | 10.8568 |
| Malpractice | 2.87 | × 0.892 | 2.5600 |
| Total RVUs | 29.1502 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$973.64
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.44 | 1.019 |
| Practice expense | 10.51 | 1.033 |
| Malpractice | 2.87 | 0.892 |
(15.44 × 1.019 + 10.51 × 1.033 + 2.87 × 0.892) × $33.4009 = $973.64
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.
40761 billing questions
How is this different from 40720?
40761 is for secondary cleft lip/nasal repair with a cross-lip flap. Use 40720 for the corresponding secondary cross-lip repair when nasal repair is not part of the service.
Can this be reported for a direct revision without a flap?
No. This code describes reconstruction using a cross-lip flap; secondary repair by recreating the defect and closing it is represented by a different code.
Is the flap donor-site closure separately reported?
No. Closure of the donor site is included in this service.
Should modifier 50 be used for bilateral anatomy?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What global care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant-at-surgery service for this code. Co-surgeons and team surgery are 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 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.
4,85040720,,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
4,8514073F,,Oral antiplat thx rx dischrg,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
4,8524075F,,Anticoag thx rx at dischrg,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
4,85340761,,Repair cleft lip/nasal,A,,15.44,10.51,NA,10.51,,2.87,28.82,28.82,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8544077F,,Doc t-pa admin considered,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
4,85540799,,Unlisted procedure lips,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8564079F,,Doc rehab svcs considered,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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537