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See a sample rate comparisonCPT 40520 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.
Xcision Of Lip; V-Xcision W/ Primar Direct Linear Closur, Excision Of Lip; V-Excision With Primary Direct Linear Closure
| 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 | GC - Service performed by resident under supervision 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $519.38 national non-facility rate (2026) · View Medicare rates for 40520 |
| Medicaid Fee Schedule | $413.40 median of the 8 states in the free preview · View Medicaid rates for 40520 |
National average reimbursement for CPT 40520 by major payers:
$600.47
$656.21
$680.82
$609.45
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CPT 40520
5 of 25 sample ratesHigher to lower in this preview
Los Gatos Surgical Center, A California Limited Partnership, Endoscopy Center Of Silicon Valley
$3,933.00Published rateResurgens East Surgery Center, LLC
Resurgens East Surgery Center LLC
$839.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$565.00Published rateNovamed Management Services LLC, Atlanta Eye Surgery Center
Novamed, Inc.
$496.00Published ratePhysicians Surgery Center LLC
$298.00Published rate
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See a sample payer proposalCPT 40520 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40520 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 40520 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 |
|---|---|---|
| 40510-CPT | Moderate | Xcision Of Lip; Transvers Wedge Xcision W/ Primar Closur, Excision Of Lip; Transverse Wedge Excision With Primary Closure |
| 40520-CPT | Moderate | Xcision Of Lip; V-Xcision W/ Primar Direct Linear Closur, Excision Of Lip; V-Excision With Primary Direct Linear Closure |
| 40525-CPT | Moderate | Xcision Of Lip; Full Thickns Reconstr W/ Local Flap, Excision Of Lip; Full Thickness Reconstruction With Local Flap (Eg E |
| 40652-CPT | Moderate | Rep Lip Full Thick < 1/2 Hgt |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40520. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40520 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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