$590.96–$670.63
Choose 40650 when the full-thickness repair is limited to the vermilion. This code describes a full-thickness injury involving less than half the lip’s vertical height.
On this page
CMS RVU26D · Effective 2026-10-01
40652 Lip repair Medicare reimbursement rates in Washington
Repair a full-thickness lip injury extending through the lip but involving less than half its vertical height, with extent and tissue involvement documented. Compare 40652 office and facility rates across CMS payment localities in Washington.
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 40652 in Washington?
Washington 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
$589.42–$666.09
2 of 2 localities have a supported rate.
Facility setting
$367.49–$407.49
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.
Facial surgery
About 40652: Full-thickness lip repair below half height
Repair a full-thickness lip injury extending through the lip but involving less than half its vertical height, with extent and tissue involvement documented.
This code describes repair of a full-thickness lip injury that extends through the lip but involves less than half its vertical height. The injury may involve the external skin, lip muscle, and inner oral lining. A physician or other qualified surgeon typically performs the repair in an emergency department, operating room, or other setting where the injury is treated. Precise alignment of the lip edges, including the vermilion border when involved, helps restore the lip’s contour.
Choose the code based on the injury’s depth and vertical extent, and document the involved layers and proportion of lip height affected. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 40652
- 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 RVU4.32 · 25%
- Practice expense (office) RVU12.01 · 70%
- Malpractice RVU0.82 · 5%
249
Medicare services in 2024 · #4142 by national volume
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.
40652 compared with similar codes
Office rates for Washington, from the same CMS release.
$633.74–$713.20
Choose 40654 when the full-thickness repair involves more than half the lip’s vertical height or is complex; this code is for the less-than-half-height repair.
$143.38–$162.01
12011 describes repair of qualifying superficial facial wounds, including lip wounds. It is not the choice for a full-thickness injury extending through the lip.
Compare 40652 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
Rest Of Washington →
Office / nonfacility
$589.42
Facility
$367.49
Seattle (King Cnty) →
Office / nonfacility
$666.09
Facility
$407.49
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40652 billing questions
How does this differ from 40650?
40652 is for a full-thickness injury involving less than half the lip’s vertical height. 40650 is for a full-thickness repair limited to the vermilion.
When is 40654 the better choice?
Use 40654 for a full-thickness repair involving more than half the lip’s vertical height or a complex repair. Document the extent and complexity supporting that selection.
What should the operative note document?
Document that the injury is full thickness, the lip layers involved, and how much of the lip’s vertical height is affected. Include the repair details and any complexity relevant to code selection.
Can modifier 50 be used for a repair on both sides?
No. CMS identifies modifier 50 as inappropriate for this code because of its descriptor or anatomy.
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 paid?
CMS assistant-at-surgery payment is allowed 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 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.
4,8374063F,,Antidepres rxthxpy not rxd,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
4,8384064F,,Antidepressant rx,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
4,83940650,,Rpr lip fth vermilion only,A,,3.69,12.66,,5.96,,0.82,17.17,10.47,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,84040652,,Rpr lip fth<half ver height,A,,4.32,12.01,,5.70,,0.82,17.15,10.84,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,84140654,,Rpr lip fth>1half ver ht/cpx,A,,5.34,12.26,,5.63,,0.86,18.46,11.83,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8424065F,,Antipsychotic rx,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
4,8434066F,,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