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See a sample rate comparisonCPT 40819 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.
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).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 24 - Ambulatory Surgical Center |
| Common Modifiers | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $276.89 national non-facility rate (2026) · View Medicare rates for 40819 |
| Medicaid Fee Schedule | $220.85 median of the 8 states in the free preview · View Medicaid rates for 40819 |
National average reimbursement for CPT 40819 by major payers:
$351.92
$382.68
$399.11
$455.09
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CPT 40819
5 of 25 sample ratesHigher to lower in this preview
Plaza Surgery Center, L.P., Plaza Surgery Center
Plaza Surgery Center Lp
$3,711.00Published rateSurgcenter Camelback LLC
$1,276.00Published ratePortneuf Asc, LLC
Portneuf Asc LLC
$725.00Published rateOrthopaedic Associates Of Central Texas Surgery Center, LLC
Orthopaedic Associates Of Central Texas Surgery Center LLC
$632.50Published ratePalmetto Endoscopy Center
$467.00Published rate
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See a sample payer proposalCPT 40819 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40819 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 40819 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 |
| 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). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40819. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40819 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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