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See a sample rate comparisonCPT 40490 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Biopsy Lip
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Low |
| Medicare Fee Schedule | $120.24 national non-facility rate (2026) · View Medicare rates for 40490 |
| Medicaid Fee Schedule | $95.865 median of the 8 states in the free preview · View Medicaid rates for 40490 |
National average reimbursement for CPT 40490 by major payers:
$143.49
$164.63
$175.05
$124.50
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CPT 40490
5 of 25 sample ratesHigher to lower in this preview
Sjv Management, LLC, South Jersey Vascular Surgery Center
Sjv Management, LLC
$5,127.00Published rateAbilene Eye Asc Lp, Abilene Cataract And Refractive Surgery Center
Abilene Eye Asc Lp
$624.00Published rateWest Bozeman Surgery Center, LLC, Bozeman Outpatient Surgery Center
West Bozeman Surgery Center LLC
$187.00Published rateNeaman Surgery Center, LLC
Neaman Surgery Center LLC
$170.00Published rateWilmington Surgery Center
$69.00Published rate
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See a sample payer proposalCPT 40490 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40490 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 40490 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 40490-CPT | Low | Biopsy Lip |
| 40500-CPT | Moderate | Vermilionectomy (Lip Shave) W/ Mucosal Advancem, Vermilionectomy (Lip Shave) With Mucosal Advancement |
| 40510-CPT | Moderate | Xcision Of Lip; Transvers Wedge Xcision W/ Primar Closur, Excision Of Lip; Transverse Wedge Excision With Primary Closure |
| 40525-CPT | Moderate | Xcision Of Lip; Full Thickns Reconstr W/ Local Flap, Excision Of Lip; Full Thickness Reconstruction With Local Flap (Eg E |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40490. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40490 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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