Summary & Overview
CPT 40720: Secondary Repair of Cleft Lip and Nasal Deformity
CPT code 40720 identifies a secondary repair of a cleft lip and/or nasal deformity, a reconstructive procedure performed when initial cleft lip repair yields unsatisfactory outcomes. The procedure involves reopening and reclosing the surgical site to correct deformity from scar contracture, wound separation, muscle shortening, or infection that compromise appearance or function. Nationally, this code matters for surgical specialties focused on pediatric and craniofacial plastic surgery and for payers assessing coverage and medical necessity for revision procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the code, typical settings where the service is delivered, and the common operational considerations relevant to billing and claims adjudication. The publication summarizes benchmarks and policy-relevant items including coding guidance, site-of-service expectations, and common modifier usage patterns when available. The content is intended to help billing managers, clinical coders, and policy analysts understand where CPT code 40720 fits in surgical practice and payer review processes.
Billing Code Overview
CPT code 40720 describes a secondary repair of a cleft lip and/or nasal deformity. The procedure is performed when a primary repair does not produce favorable results, such as scar contracture, wound dehiscence, shortening or tightening of muscle that restricts movement, or infection. In this operation the provider reopens the defect and recloses the surgical site to improve form and function.
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Service type: Reconstructive/plastic surgery — secondary cleft lip and nasal deformity repair
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 7-year-old child presents to a pediatric plastic surgery clinic with persistent nostril asymmetry, scar contracture, and restricted upper lip mobility after an initial primary cleft lip repair performed in infancy. The family reports speech articulation challenges and social self-consciousness. The surgeon evaluates healing, scar tethering, and nasal cartilage position and documents objective deficits compared with expected postop outcomes. After discussion, the plan is a secondary (revision) cleft lip and/or nasal deformity repair to reopen scar tissue, release contractures, reposition muscle and nasal elements, and reclose the defect to improve appearance and function. The clinical workflow includes preoperative assessment (history, photos, anesthetic clearance), informed consent, operative revision under general anesthesia in an ambulatory surgical center or hospital operating room, intraoperative scar release, muscle repair, possible cartilage grafting or rhinoplasty maneuvers, layered closure, postoperative recovery and wound care instructions, and scheduled follow-up visits to monitor healing and functional outcomes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the revision required substantially greater work than usual due to extensive scar excision, complex muscle repair, or concurrent nasal reconstruction. |