Billing code 40720: Cleft repairMedicare rate & RVUs in Texas
Revision surgery for residual cleft-related lip or nasal deformity in an adolescent or adult after an earlier cleft repair.
CMS doesn’t publish an office rate for 40720 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 40720 covers
This service addresses a residual or recurrent lip or nasal deformity after prior cleft repair in an adolescent or adult. A plastic, craniofacial, or facial plastic surgeon may revise features such as lip asymmetry, scar contour, or cleft-related nasal asymmetry. The operative work is tailored to the deformity and is generally performed in a surgical setting; it is a secondary correction rather than the initial cleft repair.
Select the code when the record supports a secondary revision in an adolescent or adult, and document the prior repair, current deformity, patient age, and operative work. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery 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 40720 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 | $933.86 |
| Beaumont | Unavailable | $884.34 |
| Brazoria | Unavailable | $903.56 |
| Dallas | Unavailable | $912.77 |
| Fort Worth | Unavailable | $910.39 |
| Galveston | Unavailable | $908.55 |
| Houston | Unavailable | $957.42 |
| Rest Of Texas | Unavailable | $895.83 |
How the 40720 rate is calculated
Each of 40720’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 · 40720
RVUs × geographic indexes × conversion factor
Work14.35
14.35 RVUs× 1.000 GPCI
Practice expense10.60
10.60 RVUs× 1.000 GPCI
Malpractice2.67
2.67 RVUs× 1.000 GPCI
Adjusted RVUs
27.6200
Conversion factor
$33.4009
Medicare rate
$922.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40720
40720 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40720
Cleft 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| 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 · 40720
Cleft 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 50 · payment effect
With and without the modifier
40720 without 50 · national facility
$922.53
Cleft repair
40720-50 · Bilateral: 150%
$1,383.80
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
40720 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 40700Cleft lip repair
- Use 40700 for primary unilateral repair of the cleft deformity. Use 40720 for secondary revision in an adolescent or adult after an earlier repair.
- 40701Cleft lip repair
- Code 40701 describes primary bilateral repair. Code 40720 describes secondary revision in an adolescent or adult.
- 40702Cleft lip repair
- Code 40702 is the secondary repair code for childhood. Code 40720 is for secondary revision in adolescence or adulthood.
40720 billing questions
How does this differ from a primary cleft repair?
This code is for secondary correction in an adolescent or adult after an earlier cleft repair. Codes 40700 and 40701 describe primary repair.
What documentation supports reporting 40720?
Document the patient's age, the prior cleft repair, the residual lip or nasal deformity, and the revision performed.
How is bilateral surgery reported?
When the service is bilateral, report modifier 50; CMS pays the bilateral procedure at 150%.
What postoperative care is included?
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 is available only when medical necessity is documented. 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 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
Fee sheets
Put 40720 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →