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See a sample rate comparisonCPT 40820 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.
Destruct Of Lesion Or Scar Of Vestibul Of Mouth By Physical Mthod, Destruction Of Lesion Or Scar Of Vestibule Of Mouth By Physical Method
| 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 | 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $252.18 national non-facility rate (2026) · View Medicare rates for 40820 |
| Medicaid Fee Schedule | $198.795 median of the 8 states in the free preview · View Medicaid rates for 40820 |
National average reimbursement for CPT 40820 by major payers:
$309.12
$334.92
$365.62
$287.96
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CPT 40820
5 of 25 sample ratesHigher to lower in this preview
The Emory Clinic Inc., Emory Aesthetic Center
Emory University
$3,188.00Published rateMid-State Endoscopy Center LLC
Midstate Endoscopy Center LLC
$1,276.00Published rateSpecialty Surgical Center Of Irvine Lp
Specialty Surgical Center Of Irvine, Lp
$800.00Published rateNoble Surgery Center
$566.00Published rateJoseph Anthony
Deaconess Hospital Inc
$212.11Published rate
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See a sample payer proposalCPT 40820 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40820 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 40820 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 |
|---|---|---|
| 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). |
| 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 40820. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40820 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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