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See a sample rate comparisonCPT 40530 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.
Resect Lip > 1/4 Wo Reconstruction
| 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 | 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $565.81 national non-facility rate (2026) · View Medicare rates for 40530 |
| Medicaid Fee Schedule | $449.265 median of the 8 states in the free preview · View Medicaid rates for 40530 |
National average reimbursement for CPT 40530 by major payers:
$631.20
$718.98
$762.77
$669.70
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CPT 40530
5 of 25 sample ratesHigher to lower in this preview
Oakwood Surgery Center, Ltd., LLP
Oakwood Surgery Center Ltd LLP
$3,993.00Published rateUniversity Of Maryland Medicine Asc, LLC, University Of Maryland Surgery Center
University Of Maryland Medicine Asc LLC
$2,196.00Published rateHillmoor Eye Surgery Center, LLC, One Day Surgery
Hillmoor Eye Surgery Center LLC
$1,005.00Published ratePcet Surgery Center LLC
$750.00Published rateMichael Sellers
Deaconess Hospital Inc
$436.95Published rate
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See a sample payer proposalCPT 40530 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40530 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 40530 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 |
|---|---|---|
| 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 |
| 40530-CPT | Moderate | Resect Lip > 1/4 Wo Reconstruction |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40530. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40530 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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