Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 40654 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.
Rpair Lip Full Thickns; Over One-Half Vertical Height Or Complx, Repair Lip Full Thickness; Over One-Half Vertical Height Or Complex
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 23 - Emergency Room 21 - Inpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $616.58 national non-facility rate (2026) · View Medicare rates for 40654 |
| Medicaid Fee Schedule | $480.675 median of the 8 states in the free preview · View Medicaid rates for 40654 |
National average reimbursement for CPT 40654 by major payers:
$678.70
$759.29
$836.60
$953.13
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 40654.
CPT 40654
5 of 25 sample ratesHigher to lower in this preview
Columbia North Hills Hospital Subsidiary Lp, Medical City North Hills
Columbia North Hills Hospital Subsidiary Lp
$4,278.00Published rateAdvanced Endoscopy And Pain Center LLC
$1,528.00Published rateSunrise Flamingo Surgery Center, LLC, Flamingo Surgery Center
Sunrise Flamingo Surgery Center LLC
$945.00Published rateCityview Surgery Center LLC, Cityview Surgery Center
Cityview Surgery Center LLC
$700.00Published rateGastroenterology Endoscopy Center
$300.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 40654 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40654 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 40654 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 |
|---|---|---|
| 40525-CPT | Moderate | Xcision Of Lip; Full Thickns Reconstr W/ Local Flap, Excision Of Lip; Full Thickness Reconstruction With Local Flap (Eg E |
| 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40654. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40654 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 40654) and we'll show you how you compare in 15 minutes or less.