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CPT 40720 Fee Schedule

Last Verified: January 2026

Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.

Rep Lip Cleft Secondary Unil
Key FactDetail
Service Type

Surgery

Surgical Procedures on the Digestive System

Common Place of Service

22 - On Campus Outpatient Hospital

24 - Ambulatory Surgical Center

Common Modifiers

None

LT - Left side of body

RT - Right side of body

Complexity LevelHigh
Medicare Fee ScheduleView Medicare rates for 40720

National average reimbursement for CPT 40720 by major payers:

bcbs

$1,350.40

uhc

$1,373.72

aetna

$1,454.67

cigna

$1,693.38

Preview provider-level rates for...
For billing codeCPT 40720
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for CPT 40720

United
40720$3000.001154400471 - ST. LOUIS WOMEN'S SURGERY CENTER, LLC, ST. LOUIS MULTISPECIALTY SURGERY CENTER680526281 - (MO) ST LOUIS WOMENS SURGERY CENTER LLCMOAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$7121.001487039517 - KC PAIN ASC, LLC464510621 - (MO) KC PAIN ASC LLCMOAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$5433.001871594275 - DESTIN SURGERY CENTER LLC593723179 - (FL) DESTIN SURGERY CENTER LLCFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$4070.001962920751 - WEST END SURGICAL, LLC, OREGON SURGICAL INSTITUTE812758812 - (OR) WEST END SURGICAL LLCORAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$3139.001396298139 - RESURGENS FAYETTE SURGERY CENTER, LLC812951222 - (GA) RESURGENS FAYETTE SURGERY CENTER LLCGAAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$2693.001114491073 - ASC DEVELOPMENT COMPANY LLC203405773 - (MD) ASC DEVELOPMENT COMPANY LLCMDAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$2253.001093088999 - CHIPPENHAM AMBULATORY SURGERY CENTER, LLC371587067 - (VA) CHIPPENHAM AMBULATORY SURGERY CENTER LLCVAAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$1085.001205809795 - OAKHURST ENDOSCOPY ASC LLC, OCEAN SURGICAL PAVILION, INC.223182653NJAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$3877.001588302707 - ALLINA HEALTH SURGERY CENTER- VADNAIS HEIGHTS LLC882406421 - (MN) ALLINA HEALTH SURGERY CENTER VADNAIS HEIGHTS LLCMNAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$1579.001386619708 - ORLANDO FL ENDOSCOPY ASC LLC, CENTRAL FLORIDA SURGICAL CENTER202873015 - ORLANDO FL ENDOSCOPY ASC LLCFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$3624.001730227992 - MEMORIAL AMBULATORY SURGERY CENTER, LLC210634562 - (NJ) VIRTUA-MEMORIAL HOSPITAL BURLINGTON COUNTY INCNJAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$2400.001891133302 - HANFORD SPECIALTY SURGERY CENTER, PC454954590 - (CA) HANFORD SPECIALTY SURGERY CENTER PCCAAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$1874.001730152869 - BEL AIR ENDOSCOPY ASC LLC, HARFORD ENDOSCOPY CENTER621827593 - (MD) BEL AIR ENDOSCOPY ASC LLCMDAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$5433.001649310111 - CROWN POINT SURGERY CENTER, LLC, CROWN POINT SURGERY CENTER810641475 - (CO) CROWN POINT SURGERY CENTER, LLCCOAmbulatory Surgical Clinic/Center (261QA1903X)
United
40720$1773.001205013273 - GLEN BURNIE MD ENDOSCOPY ASC LLC, ENDOCENTRE AT QUARTERFIELD STATION261467098MDAmbulatory Surgical Clinic/Center (261QA1903X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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CPT 40720 vs. Other Surgical Procedures on the Digestive System Codes

The CPT 40720 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 40720 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.

CodeComplexityDescription
40654-CPTModerateRep Lip Full Thick > 1/2 Hgt
40700-CPTHighRep Lip Cleft Primary Unil
40701-CPTHighRep Lip Cleft Primary Bil 1 Stg
40720-CPTHighRep Lip Cleft Secondary Unil

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40720. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 40720 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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