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See a sample rate comparisonCPT 40816 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; Comple, Excision Of Lesion Of Mucosa And Submucosa Vestibule Of Mouth; Comple
| 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 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 40816 |
| Medicaid Fee Schedule | View Medicaid rates for 40816 |
National average reimbursement for CPT 40816 by major payers:
$483.11
$524.20
$556.74
$514.66
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CPT 40816
5 of 25 sample ratesHigher to lower in this preview
Eagle Highlands Surgery Center, LLC, Meridian South Surgery Center
$8,705.00Published rateThe Outpatient Center, LLC, The Outpatient Center Of Boynton Beach, Ltd.
The Outpatient Center Of Boynton Beach, Ltd.
$2,307.00Published rateVascular Labs Of The Rockies Asc, LLC
Vascular Labs Of The Rockies Asc LLC
$1,570.00Published rateDeaconess Hospital, Inc.
Deaconess Hospital Inc
$706.20Published rateTracy Kania
Deaconess Hospital Inc
$324.47Published rate
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See a sample payer proposalCPT 40816 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40816 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 40816 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 40816. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40816 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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