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See a sample rate comparisonCPT 40799 Fee Schedule
Last Verified: October 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.
Unlisted Procedure Lips, Unlisted Procedure Lips
| 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 | GA - Required ABN issued and on file AG - Primary physician |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 40799 |
| Medicaid Fee Schedule | $177.395 median of the 2 states in the free preview · View Medicaid rates for 40799 |
National average reimbursement for CPT 40799 by major payers:
$1,202.88
$90.10
$1,908.16
$1,056.98
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CPT 40799
5 of 25 sample ratesHigher to lower in this preview
Saint Lukes-Gi Diagnostics LLC
Saint Lukesgi Diagnostics LLC
$6,623.00Published rateMngi Endoscopy Asc Inc
$532.00Published rateTallgrass Surgical Center, LLC
$348.00Published rateHurst Ambulatory Surgery Center, LLC, Precinct Ambulatory Surgery Center, LLC
Hurst Ambulatory Surgery Center LLC
$200.00Published rateGynemed Surgical Center
$40.00Published rate
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See a sample payer proposalCPT 40799 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40799 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 40799 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40799. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40799 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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