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See a sample rate comparisonCPT 40812 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.
Xcision Of Lesion Of Mucosa & Submucos Vestibul Of Mouth, Excision Of Lesion Of Mucosa And Submucosa Vestibule Of Mouth; With S
| 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 | None 59 - Distinct Procedural Service LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 40812 |
| Medicaid Fee Schedule | View Medicaid rates for 40812 |
National average reimbursement for CPT 40812 by major payers:
$327.72
$370.45
$403.13
$320.93
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CPT 40812
5 of 25 sample ratesHigher to lower in this preview
Susitna Surgery Center LLC
$4,470.00Published rateUpstate Orthopedics Ambulatory Surgery Center LLC, Upstate Orthopedics Asc
$1,181.00Published rateBarrington Pain And Spine Institute, LLC, Barrington Ambulatory Surgery Center
Barrington Pain And Spine Institute LLC
$585.00Published rateAda Hoffman
Deaconess Hospital Inc
$507.30Published rateRand Surgical Pavillion Corp
$369.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 40812 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40812 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 40812 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 |
|---|---|---|
| 40812-CPT | Moderate | Xcision Of Lesion Of Mucosa & Submucos Vestibul Of Mouth, Excision Of Lesion Of Mucosa And Submucosa Vestibule Of Mouth; With S |
| 40814-CPT | Moderate | Xcision Of Lesion Of Mucosa & Submucos Vestibul Of Mouth, Excision Of Lesion Of Mucosa And Submucosa Vestibule Of Mouth; With C |
| 40816-CPT | Moderate | Xcision Of Lesion Of Mucosa & Submucos Vestibul Of Mouth; Comple, Excision Of Lesion Of Mucosa And Submucosa Vestibule Of Mouth; Comple |
| 40818-CPT | Moderate | Exc Mucosa Oral Vestibule For Graft |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40812. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40812 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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