👄 CPT 40650 — Repair Lip, Full Thickness; Vermilion Only
Quick Reference
wRVU: 3.69 | Global Period: 000 | Assistant Payable: No, under usual Medicare assistant-at-surgery policy | Bilateral Indicator: 0 Rule: CPT 40650 reports repair of a full-thickness wound confined to the vermilion portion of the lip. It does not describe a full-thickness wound extending beyond the vermilion onto adjacent facial skin. The 0-day global period includes only the day of the procedure and customary immediate postoperative care.1
📋 Clinical Description
CPT 40650 describes repair of a full-thickness lip laceration or defect confined to the vermilion. The service includes approximation of the involved lip layers needed to restore continuity, contour, and function of the vermilion portion of the lip. The record should identify the lip involved, whether the wound is full thickness, the vermilion-only location, wound characteristics, repair technique, and any debridement necessary to complete the repair. A simple superficial closure that does not involve full thickness of the lip does not support this code.2
Code selection within the full-thickness lip-repair family depends on wound extent. Use 40650 when the repair is limited to vermilion only; use 40652 when a full-thickness repair extends beyond the vermilion and involves up to one-half of the vertical height of the lip; use 40654 when it extends beyond the vermilion over one-half of the vertical height or is complex. Do not select a code based only on the number of sutures, cosmetic concern, or patient age; the documented wound depth, location, and vertical extent control code selection.2
This procedure may be performed in the following clinical contexts:
- Traumatic vermilion laceration — A full-thickness injury confined to the vermilion is repaired after trauma. Document the presence or absence of foreign body and the initial, subsequent, or sequela encounter character.
- Avulsion-related vermilion defect — A traumatic partial avulsion confined to the vermilion may require layered full-thickness repair. The operative report should distinguish a repair from more extensive reconstruction.
- Scar revision involving vermilion only — A scar or prior wound defect limited to the vermilion may be excised and repaired when the documentation supports full-thickness repair. Do not use 40650 for a superficial cosmetic scar treatment without full-thickness repair.
- Postprocedural vermilion wound defect — A clinically significant vermilion defect after another procedure may require repair. Code the documented complication separately only when the provider establishes it.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Vermilion-only full-thickness repair | The laceration or defect is confined to the vermilion of the upper or lower lip. Repair restores alignment and continuity of the involved full-thickness tissue. | This is the circumstance represented by 40650. The note should clearly establish that the wound is full thickness and limited to the vermilion. |
| Repair extending beyond vermilion up to one-half vertical height | The full-thickness wound crosses beyond the vermilion into surrounding lip or skin and involves up to one-half the lip’s vertical height. The repair involves a broader anatomic defect. | Report 40652 when the documentation supports this extent. Do not report 40650 merely because the vermilion is also involved. |
| Repair extending beyond one-half vertical height or complex repair | The full-thickness wound extends beyond the vermilion over one-half the lip’s vertical height or requires complex repair. The documentation supports greater extent or complexity than the other family codes. | Report 40654 when these requirements are met. Complexity must be supported by the operative-report details rather than inferred from trauma severity alone. |
Clinical Pearl
Vermilion alignment is clinically important, but the CPT choice requires more than a statement that the vermilion border was approximated. The documentation must establish full-thickness repair and whether the wound is confined to vermilion only or extends beyond it. If the wound description is incomplete, query rather than defaulting to 40650.2
✅ Procedure Includes
- Repair and approximation of the full-thickness vermilion wound or defect.
- Routine wound preparation and hemostasis necessary to perform the repair.
- Suturing and closure required to restore lip contour and continuity.
- Routine local care on the date of service associated with the 0-day global surgical package.
- Limited debridement integral to preparing the wound for the documented repair.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 40652 | Repair lip, full thickness; up to half vertical height | Do not report with 40650 for the same wound. Use 40652 when the full-thickness wound extends beyond the vermilion and involves up to one-half of the lip’s vertical height. |
| 40654 | Repair lip, full thickness; over one-half vertical height, or complex | Do not report with 40650 for the same wound. Use 40654 when the wound extends beyond the vermilion over one-half the vertical height or when the repair is complex. |
| 12011 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less | Do not separately report superficial simple-repair work that is part of the same full-thickness lip repair. A distinct wound at a separate site may be separately reportable when documentation supports it. |
| 12013 | Intermediate repair of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm | Do not use an intermediate-closure code instead of 40650 for the same full-thickness vermilion injury. If a separate wound is repaired, retain documentation of its distinct location and repair. |
| 13151 | Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.0 cm to 2.5 cm | Do not report complex repair in addition to 40650 for the same wound. Select the code that best represents the documented full-thickness lip repair. |
Bundling Alert
CPT 40650 has a 0-day global period. Routine same-day follow-up, expected wound-care instructions, and usual immediate postprocedure management are included. Report a same-day E/M service with -25 only when it is significant and separately identifiable from the evaluation and work required for the repair; do not use -59 merely to bypass an edit for services integral to wound repair.1
🌳 Code Tree — Surgery: Repair Procedures On The Lips
CPT 40650-40654 Repair Procedures on the Lips
│
├── 40650 Repair lip, full thickness; vermilion only (Global: 000)
│
├── 40652-40654 Repair lip, full thickness
│ ├── ▶▶ 40650 ◀◀ Repair lip, full thickness; vermilion only ← YOU ARE HERE (Global: 000)
│ ├── 40652 Repair lip, full thickness; up to half vertical height (Global: 000)
│ └── 40654 Repair lip, full thickness; over one-half vertical height, or complex (Global: 000)
│
└── 40700 Plastic repair of cleft lip, primary; partial or complete, unilateral💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 3.69 |
| Global Period | 000 |
| Bilateral Indicator | 0 |
| Assistant Surgeon | 0 — Assistant at surgery does not apply |
| Co‑Surgeon | 0 — Co-surgery does not apply |
| Team Surgery | 0 — Team surgery does not apply |
| PC/TC Split | 0 — Physician service; PC/TC concept does not apply |
| Modifier -51 Exempt | No |
| Anesthesia | Local anesthesia is typically included when performed by the surgeon; separately report anesthesia only when provided by a qualified anesthesia practitioner and medically necessary |
Bilateral Billing Rules
The CMS PFS bilateral indicator for 40650 is 0. The standard Medicare 150% bilateral-procedure adjustment does not apply, so do not append -50 solely because more than one lip site is repaired. When separately reportable wounds are treated, document each wound’s distinct location, depth, repair type, and medical necessity, then follow payer-specific multiple-procedure rules.1
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -25 | Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service | Append to the E/M service, not 40650, when a significant and separately identifiable E/M service is performed on the repair date. Routine evaluation needed to perform the repair does not support -25. |
| -51 | Multiple Procedures | Use when multiple separately reportable procedures are performed during the same operative session, subject to payer requirements. Do not use it to separately bill work integral to the lip repair. |
| -52 | Reduced Services | Use when the planned service is reduced at the physician’s discretion and the record describes the reduced work. It is not used for a procedure discontinued due to unforeseen patient-safety circumstances. |
| -53 | Discontinued Procedure | Use when the procedure is started but discontinued because of extenuating circumstances or a threat to patient well-being. The record must state the reason for discontinuation and the work completed. |
| -59 | Distinct Procedural Service | Use only when documentation supports a separate site, separate lesion, separate encounter, or independent service and no more specific modifier applies. It must not be used to unbundle routine wound preparation or closure. |
| -76 | Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional | Use only when the same procedure is repeated by the same physician or other qualified health care professional and documentation supports a true repeat service. It is not a substitute for reporting a repair of a different wound. |
| -77 | Repeat Procedure by Another Physician or Other Qualified Health Care Professional | Use only when another physician or qualified health care professional repeats the same procedure and documentation supports repeat performance. Verify payer-specific repeat-procedure requirements. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| S01.511A | Laceration without foreign body of lip, initial encounter | No | Use for active treatment of a lip laceration without retained foreign body. Initial encounter includes surgical treatment, emergency treatment, and other active treatment. |
| S01.512A | Laceration with foreign body of lip, initial encounter | No | Use when the provider documents a lip laceration with retained foreign material. Code any documented foreign-body management when separately reportable and supported. |
| S01.501A | Unspecified open wound of lip, initial encounter | No | Use only when the provider documents an open wound of the lip but does not specify laceration type or foreign-body status. Query when the clinical documentation supports greater specificity. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| S01.511D | Laceration without foreign body of lip, subsequent encounter | No | Use for routine care during healing or recovery after active treatment is complete. Do not use for the initial repair encounter. |
| S01.512D | Laceration with foreign body of lip, subsequent encounter | No | Use for subsequent-care encounters after active treatment of a lip laceration with foreign body. Confirm that foreign-body status remains clinically relevant. |
| S01.501D | Unspecified open wound of lip, subsequent encounter | No | Use for subsequent routine healing care only when the wound remains unspecified. Use a more specific injury code whenever supported. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| S01.511S | Laceration without foreign body of lip, sequela | No | Use for a residual condition directly attributable to a prior lip laceration after the acute phase has ended. Code the current residual condition first when applicable. |
| S01.512S | Laceration with foreign body of lip, sequela | No | Use for a residual condition caused by a prior lip laceration with foreign body. Do not use the sequela character during active treatment or routine healing. |
Coding Specificity Reminder
Select the seventh character based on the treatment phase, not on whether the patient is new to the practice. Use initial encounter for active treatment, subsequent encounter for routine healing or recovery, and sequela for residual effects after the acute injury has resolved. Code the most specific documented injury type and foreign-body status.3
🏥 MS‑DRG Considerations
CPT 40650 does not independently determine an MS-DRG because MS-DRG assignment is based on the complete inpatient ICD-10-CM and ICD-10-PCS coding and discharge record. Inpatient lip repair may be reported with a PCS repair code reflecting the upper or lower lip and the documented approach, but most isolated traumatic lip repairs are outpatient or emergency-department services. No nationwide NCD specifically governing CPT 40650 was identified, and no universally applicable LCD was identified in the Medicare Coverage Database review. The CMS PFS Lookup tool provides payment and policy indicators, such as RVUs and global days, but it does not establish medical-necessity coverage; verify MAC- and jurisdiction-specific LCDs or billing-and-coding articles when applicable.145
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 0CQ0XZZ | Repair Upper Lip, External Approach | External repair |
| 0CQ1XZZ | Repair Lower Lip, External Approach | External repair |
| 0CQ00ZZ | Repair Upper Lip, Open Approach | Open repair |
| 0CQ10ZZ | Repair Lower Lip, Open Approach | Open repair |
CPT 40650 does not map one-to-one to ICD-10-PCS. The inpatient PCS code is selected from the actual upper or lower lip repaired and the documented approach; the PCS root operation is Repair because the objective is restoration of the lip’s normal anatomic structure and function. An external approach may be appropriate when the procedure is performed directly on a visible lip structure without instrumentation, while an open approach requires cutting through skin or mucous membrane and other layers to expose the site.5
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical. This PCS section includes operative procedures performed to restore or alter body structures. |
| 2 | Body System | C | Mouth and Throat. The lip is classified in this PCS body system. |
| 3 | Root Operation | Q | Repair. Repair means restoring, to the extent possible, a body part to its normal anatomic structure and function. |
| 4 | Body Part | 0 or 1 | 0 identifies upper lip and 1 identifies lower lip. Select the documented lip repaired. |
| 5 | Approach | X or 0 | X is external and 0 is open. The approach is based on the PCS approach definition and operative technique. |
| 6 | Device | Z | No device. Select another device value only when a device remains in place at the conclusion of the procedure and the PCS table directs that value. |
| 7 | Qualifier | Z | No qualifier. Use another qualifier only when supported by the applicable PCS table and operative documentation. |
Root Operation Comparison
- Repair is appropriate when the clinical objective is restoration of the traumatic or acquired lip defect. This is the usual PCS root operation for a laceration repair.
- Reposition is not assigned merely because the clinician aligns tissue edges. Reposition applies when the objective is moving a body part to its normal location or another suitable location.
- Excision may be separately considered only when tissue is actually cut out or off and that work is not integral to the repair**. Minor wound-edge preparation** is generally integral to repair.
📝 Coding Examples
Example 1
Clinical Scenario: A patient presents to the emergency department after a fall with a full-thickness 1.4 cm laceration confined to the lower-lip vermilion. The physician irrigates the wound, confirms there is no retained foreign body, aligns the vermilion, and performs layered repair. No separate, significant E/M service beyond the work required for the repair is documented.
| Field | Code | Rationale |
|---|---|---|
| CPT | 40650 | The documentation supports a full-thickness lip repair limited to the vermilion. |
| PDx | S01.511A | The patient receives active treatment for a lip laceration without foreign body. |
Note
The note should identify full-thickness involvement and vermilion-only location. Do not separately report a simple or intermediate repair code for the same repaired wound.
Example 2
Clinical Scenario: A patient has a full-thickness lip laceration extending from the vermilion into adjacent skin and involving less than one-half of the vertical lip height. The surgeon performs layered closure and documents the wound extent. A full-thickness vermilion-only repair is not documented.
| Field | Code | Rationale |
|---|---|---|
| CPT | 40652 | The wound extends beyond the vermilion and involves up to one-half of the lip’s vertical height. |
| PDx | S01.512A | The record documents active treatment of a lip laceration with foreign body. |
Warning
Do not report 40650 when the full-thickness wound extends beyond the vermilion. The documented anatomic extent requires selection of the appropriate alternative full-thickness lip-repair code.
Example 3
Clinical Scenario: A patient presents with a full-thickness vermilion-only laceration and also receives a separately identifiable evaluation for an unrelated acute otitis complaint. The clinician performs and documents a medically necessary E/M service that is significant and separately identifiable from the laceration-repair work.
| Field | Code | Rationale |
|---|---|---|
| CPT | 40650 | The laceration repair is confined to vermilion and is full thickness. |
| CPT | E/M service--25 | The E/M modifier is appended only because the unrelated E/M service is separately documented and exceeds the usual evaluation for repair. |
| PDx | S01.511A | The lip laceration is actively treated. |
Global period reminder
CPT 40650 has a 0-day global period. Same-day E/M reporting requires separate documentation and must not represent routine pre-repair evaluation.
⚠️ Common Coding Pitfalls
- Pitfall 1: Reporting 40650 for a superficial vermilion laceration. The code requires a full-thickness repair, so use the appropriate wound-repair code when the injury is not full thickness.
- Pitfall 2: Reporting 40650 when the wound extends beyond the vermilion. Select 40652 or 40654 based on the documented vertical extent and complexity.
- Pitfall 3: Selecting the code based on laceration length alone. The full-thickness lip-repair family is selected by anatomic extent and complexity, not by length alone.
- Pitfall 4: Reporting simple, intermediate, or complex closure codes in addition to 40650 for the same wound. Closure work integral to the full-thickness lip repair is included.
- Pitfall 5: Assigning the incorrect injury seventh character. Initial encounter applies during active treatment, while subsequent encounter is used during routine healing and sequela is used for residual effects.
- Pitfall 6: Appending -25 to every emergency-department repair claim. The E/M service must be significant and separately identifiable from the usual evaluation and work required to perform the repair.
📎 Sources
1 Centers for Medicare & Medicaid Services. Medicare Physician Fee Schedule Look-Up Tool and CY 2026 PFS Relative Value Files, 2026. CPT 40650: work RVU 3.69, total RVU 17.17, global period 000, bilateral-surgery indicator 0, and PC/TC indicator 0.
2 American Medical Association. Current Procedural Terminology, CPT 2026 Professional Edition. Full-thickness lip-repair family 40650, 40652, and 40654.
3 Centers for Medicare & Medicaid Services. ICD-10-CM Official Guidelines for Coding and Reporting and FY 2026 ICD-10-CM code set, 2026.
4 Centers for Medicare & Medicaid Services. Medicare Coverage Database Search, reviewed August 10, 2026. No nationwide NCD or universally applicable LCD specifically governing CPT 40650 was identified; verify active MAC-specific LCDs and billing-and-coding articles for the applicable jurisdiction.
5 Centers for Medicare & Medicaid Services. FY 2026 ICD-10-PCS Official Guidelines for Coding and Reporting and ICD-10-PCS Table 0CQ, 2026.
Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.