No office rate
40700 is for a primary repair on one side; 40701 describes primary repair of a bilateral cleft.
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CMS RVU26D · Effective 2026-10-01
40700 Cleft lip repair Medicare reimbursement rates in Texas
Reports initial surgical reconstruction of one side of a cleft lip, including associated nasal deformity repair, for partial or complete clefts. Compare 40700 office and facility rates across CMS payment localities in Texas.
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 40700 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
No 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.
Where 40700 pays more and less in Texas
Plastic surgery
About 40700: Primary unilateral cleft lip repair
Reports initial surgical reconstruction of one side of a cleft lip, including associated nasal deformity repair, for partial or complete clefts.
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.
CMS billing rules for 40700
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU13.82 · 51%
- Practice expense (office) RVU10.90 · 40%
- Malpractice RVU2.57 · 9%
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 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
40700 is the initial repair. 40702 describes a secondary operation that recreates the defect before closure.
No office rate
Use 40720 for an intermediate secondary repair, not the initial unilateral repair reported with 40700.
No office rate
40761 describes extensive secondary repair requiring osteotomies; 40700 is for primary unilateral repair.
Compare 40700 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office Unavailable | Facility $923.76 |
| Beaumont | Office Unavailable | Facility $872.65 |
| Brazoria | Office Unavailable | Facility $893.04 |
| Dallas | Office Unavailable | Facility $902.02 |
| Fort Worth | Office Unavailable | Facility $899.49 |
| Galveston | Office Unavailable | Facility $897.89 |
| Houston | Office Unavailable | Facility $944.93 |
| Rest Of Texas | Office Unavailable | Facility $884.62 |
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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 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.
4,8434066F,,Ect provided,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
4,8444067F,,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