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See a sample rate comparisonCPT 40806 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.
Cut Tissue Joining Lip To Gum, Surgery To Cut The Labial Frenum (The Tag Of Tissue In The Center Of The Upper And Lower Lip That Joins The Lip To The Gums).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $101.21 national non-facility rate (2026) · View Medicare rates for 40806 |
| Medicaid Fee Schedule | $79.545 median of the 8 states in the free preview · View Medicaid rates for 40806 |
National average reimbursement for CPT 40806 by major payers:
$119.69
$134.67
$147.34
$65.07
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CPT 40806
5 of 25 sample ratesHigher to lower in this preview
Iu Health Southwest Fort Wayne Ambulatory Surgery Center LLC, Iu Health Surgery Center Fort Wayne
Iu Health Southwest Fort Wayne Ambulatory Surgery Center LLC
$4,613.00Published rateCarillon Surgery Center LLC
$664.00Published rateSurgcenter Tucson, LLC
$555.00Published ratePermian Basin Surgical Care Center, LLC, Vista Surgery Center
Permian Basin Surgical Care Center LLC
$150.00Published rateAmbulatory Foot And Ankle Center, Inc.
Ambulatory Foot And Ankle Center Inc
$51.00Published rate
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See a sample payer proposalCPT 40806 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40806 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 40806 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 |
|---|---|---|
| 40806-CPT | Low | Cut Tissue Joining Lip To Gum, Surgery To Cut The Labial Frenum (The Tag Of Tissue In The Center Of The Upper And Lower Lip That Joins The Lip To The Gums). |
| 40818-CPT | Moderate | Exc Mucosa Oral Vestibule For Graft |
| 40819-CPT | Moderate | Remove Mouth Tissue, Surgical Removal Of Labial Frenum (The Connecting Fold Of Tissue That Joins The Lips To The Gums At The Midline) Or The Buccal Frenum (Band Of Tissue That Connects The Dental Ridge To The Cheek). |
| 40820-CPT | Moderate | Destruct Of Lesion Or Scar Of Vestibul Of Mouth By Physical Mthod, Destruction Of Lesion Or Scar Of Vestibule Of Mouth By Physical Method |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40806. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40806 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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