Billing code 40702: Cleft lip repairMedicare rate & RVUs in Texas
Reports secondary surgical repair of a bilateral cleft lip and associated nasal deformity in an infant, rather than primary repair or later revision.
CMS doesn’t publish an office rate for 40702 in Texas.
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 40702 covers
This code describes secondary repair of a bilateral cleft lip and associated nasal deformity in infancy, before age four. A plastic, craniofacial, or other appropriately trained surgeon typically performs the reconstruction in an operating room, often at a children’s hospital. The service addresses residual deformity after an earlier repair; it is distinct from the initial repair of the cleft.
Select the code based on the secondary nature of the operation, the patient’s age, and bilateral involvement. The operative report should establish the prior repair and describe the lip and nasal deformities treated. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple 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. The code is priced bilaterally, so modifier 50 does not increase payment. Assistant-at-surgery payment may be made; co-surgeon and team-surgery payment 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 40702 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $910.82 |
| Beaumont | Unavailable | $861.98 |
| Brazoria | Unavailable | $881.11 |
| Dallas | Unavailable | $890.04 |
| Fort Worth | Unavailable | $887.67 |
| Galveston | Unavailable | $885.94 |
| Houston | Unavailable | $933.16 |
| Rest Of Texas | Unavailable | $873.34 |
How the 40702 rate is calculated
Each of 40702’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 · 40702
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 13.91Practice expense 10.44Malpractice 2.58
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 40702
40702 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40702
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) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| 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 · 40702
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
40702 without 51 · national facility
$899.49
Cleft lip repair
40702-51 · Second procedure: 50%
$449.75
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%).
40702 compared with similar codes
Compare codes
40702 vs 40701 vs 40700 vs 40720: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 40701Cleft lip repair
- 40701 is for primary bilateral repair. This code is for secondary repair in infancy after an earlier cleft repair.
- 40700Cleft lip repair
- 40700 describes primary unilateral repair; this code describes secondary bilateral repair in infancy.
- 40720Cleft repair
- Both describe secondary repair, but 40720 is for an older child or adult; this code is for infancy.
40702 billing questions
When should this code be chosen instead of 40701?
Use this code for secondary repair in infancy. Code 40701 describes primary bilateral repair, not revision after an earlier repair.
Should modifier 50 be appended for bilateral repair?
The code is already priced as bilateral. Modifier 50 does not increase its payment.
Does the global period include related postoperative care?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be reported?
Assistant-at-surgery payment may be made. CMS does not permit co-surgeon or team-surgery payment for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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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