No office rate
Choose 40527 when the full-thickness reconstruction uses a cross-lip flap. 40525 describes reconstruction with a local flap.
On this page
CMS RVU26D · Effective 2026-10-01
40525 Lip reconstruction Medicare reimbursement rates in Wisconsin
Report 40525 for full-thickness lip reconstruction using a local flap to restore tissue after a defect from surgery, trauma, or a congenital condition. Compare 40525 office and facility rates across CMS payment localities in Wisconsin.
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 40525 in Wisconsin?
Wisconsin 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
$461.60
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 40525: Full-thickness lip reconstruction with local flap
Report 40525 for full-thickness lip reconstruction using a local flap to restore tissue after a defect from surgery, trauma, or a congenital condition.
This service reconstructs a full-thickness lip defect by moving nearby tissue on a local flap to restore the lip’s contour and continuity. Plastic surgeons, otolaryngologists, and oral and maxillofacial surgeons may perform it after tumor removal, traumatic injury, or repair of a congenital defect. The reconstruction may involve the lip’s skin, muscle, and mucosal lining, depending on the defect.
Report 40525 when the operative work is full-thickness reconstruction with a local flap, rather than a cross-lip flap or an excision service alone. The operative report should identify the defect and its cause, the full-thickness involvement, the flap used, and how the tissue was transferred and inset. This major surgery includes 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 other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 40525
- 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 RVU7.53 · 51%
- Practice expense (office) RVU6.18 · 41%
- Malpractice RVU1.20 · 8%
184
Medicare services in 2024 · #4393 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.
40525 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$469.02
40510 describes an excision service. Use 40525 when the reported work is reconstruction of a full-thickness lip defect with a local flap.
$488.49
40520 is an excision-oriented lip procedure; 40525 is for full-thickness reconstruction using a local flap.
Compare 40525 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$461.60
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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 40525 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
4,826
- Code
- 40525
- Physician work
- 7.53
- Practice expense
- 6.18
- Malpractice
- 1.20
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.53 | × 1.000 | 7.5300 |
| Practice expense | 6.18 | × 0.958 | 5.9204 |
| Malpractice | 1.20 | × 0.308 | 0.3696 |
| Total RVUs | 13.8200 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$461.60
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.53 | 1 |
| Practice expense | 6.18 | 0.958 |
| Malpractice | 1.2 | 0.308 |
(7.53 × 1 + 6.18 × 0.958 + 1.2 × 0.308) × $33.4009 = $461.60
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.
40525 billing questions
How does 40525 differ from 40527?
40525 is for full-thickness reconstruction using a local flap. 40527 is the related code for reconstruction with a cross-lip flap.
Can 40525 be reported with the procedure that created the lip defect?
When reconstruction and another procedure are performed in the same session, report the services supported by the operative work. The standard multiple procedure reduction applies to other procedures in that session.
What documentation supports 40525?
Document the full-thickness defect, its cause and extent, the local flap used, and the tissue transfer and inset performed.
Should modifier 50 be used for a lip defect involving both sides?
No. The CMS bilateral adjustment does not apply to 40525, and modifier 50 is inappropriate.
Is an assistant surgeon separately payable for 40525?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are also not permitted.
Does 40525 include postoperative visits?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
4,82340510,,Partial excision of lip,A,,4.70,9.53,,4.11,,0.69,14.92,9.50,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8244051F,,Referred for an av fistula,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
4,82540520,,Partial excision of lip,A,,4.67,10.16,,4.40,,0.72,15.55,9.79,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,82640525,,Reconstruct lip with flap,A,,7.53,6.18,NA,6.18,,1.20,14.91,14.91,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,82740527,,Reconstruct lip with flap,A,,9.09,6.16,NA,6.16,,1.32,16.57,16.57,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8284052F,,Hemodialysis via av fistula,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
4,82940530,,Partial removal of lip,A,,5.40,10.68,,4.73,,0.86,16.94,10.99,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,