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See a sample rate comparisonCPT 40527 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; Full Thickns Reconstr W/ Cross Lip Flap, Excision Of Lip; Full Thickness Reconstruction With Cross Lip Flap (A
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | GC - Service performed by resident under supervision 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $553.45 national non-facility rate (2026) · View Medicare rates for 40527 |
| Medicaid Fee Schedule | $485.89 median of the 8 states in the free preview · View Medicaid rates for 40527 |
National average reimbursement for CPT 40527 by major payers:
$805.56
$847.94
$878.58
$1,035.03
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CPT 40527
5 of 25 sample ratesHigher to lower in this preview
University Center For Ambulatory Surgery, LLC
University Center For Ambulatory Surgery LLC
$3,422.00Published rateUnion Surgery Center, LLC
Union Surgery Center LLC
$2,652.00Published rateFirst Coast Orthopedic Center, LLC, First Coast Surgery Center
First Coast Orthopedic Center LLC
$2,025.00Published rateMeadowview Asc, LLC
Meadowview Asc LLC
$1,435.00Published rateKleinert Kutz Surgery Center, LLC
Kleinert Kutz Surgery Center LLC
$521.20Published rate
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See a sample payer proposalCPT 40527 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40527 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 40527 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 |
| 40527-CPT | Moderate | Xcision Of Lip; Full Thickns Reconstr W/ Cross Lip Flap, Excision Of Lip; Full Thickness Reconstruction With Cross Lip Flap (A |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40527. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40527 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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