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See a sample rate comparisonCPT 40652 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.
Rep Lip Full Thick < 1/2 Hgt
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 23 - Emergency Room 11 - Office |
| Common Modifiers | 54 - Surgical Care Only GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $572.83 national non-facility rate (2026) · View Medicare rates for 40652 |
| Medicaid Fee Schedule | $445.035 median of the 8 states in the free preview · View Medicaid rates for 40652 |
National average reimbursement for CPT 40652 by major payers:
$633.93
$659.63
$703.10
$802.45
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CPT 40652
5 of 25 sample ratesHigher to lower in this preview
Mansfield Surgical Plaza LLC, Mansfield Surgery Center
$1,446.00Published rateLindsey Bowers
Deaconess Hospital Inc
$401.14Published rateCleveland Childrens Surgery Center LLC
$200.00Published rateRockville Md Endoscopy Asc LLC, Gastrointestinal Endoscopy Associates (Giea)
Rockville Md Endoscopy Asc LLC
$104.00Published rateAdvanced Vision Surgery Center LLC
$58.00Published rate
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See a sample payer proposalCPT 40652 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40652 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 40652 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 |
|---|---|---|
| 40650-CPT | Moderate | Rep Lip Full Thick Vermilion Only |
| 40652-CPT | Moderate | Rep Lip Full Thick < 1/2 Hgt |
| 40654-CPT | Moderate | Rpair Lip Full Thickns; Over One-Half Vertical Height Or Complx, Repair Lip Full Thickness; Over One-Half Vertical Height Or Complex |
| 40700-CPT | High | Plstic Rpair Of Clft Lip/Nasal Dformity; Primar Partial Or Compl, Plastic Repair Of Cleft Lip/Nasal Deformity; Primary Partial Or Compl |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40652. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40652 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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