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See a sample rate comparisonCPT 40831 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.
Closure Of Laceration Vestibu, Closure Of Laceration Vestibule Of Mouth Over 2.5 Cm Orcomplex Closure Of Laceration Vestibule Of Mouth Over 2.5 Cm Or
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $312.63 national non-facility rate (2026) · View Medicare rates for 40831 |
| Medicaid Fee Schedule | $244.69 median of the 8 states in the free preview · View Medicaid rates for 40831 |
National average reimbursement for CPT 40831 by major payers:
$369.20
$442.37
$443.48
$495.86
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CPT 40831
5 of 25 sample ratesHigher to lower in this preview
Atlantic Gastro Surgicenter, LLC, T/A Access
Atlantic Gastroenterology Associates, P.A.
$1,708.00Published rateAsc Of Trinity, Comprehensive Outpatient Joint And Spine Institute
Asc Of Trinity
$555.00Published rateRancho Mirage Surgery Center, LLC, Rancho Mirage Surgery Center
Rancho Mirage Surgery Center, LLC
$210.00Published rateChase Gardens Surgery Center LLC
$150.00Published rateSouthside Foot Clinic Of Shreveport Inc A Professional Corporation, The Foot Surgery Center Of Shreveport
Southside Foot Clinic Of Shreveport Inc A Professional Corporation
$83.00Published rate
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See a sample payer proposalCPT 40831 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40831 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 40831 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 |
|---|---|---|
| 40830-CPT | Moderate | Closure Of Laceration Vestibu, Closure Of Laceration Vestibule Of Mouth 2.5 Cm Or Lessclosure Of Laceration Vestibule Of Mouth 2.5 Cm Or Less |
| 40831-CPT | Moderate | Closure Of Laceration Vestibu, Closure Of Laceration Vestibule Of Mouth Over 2.5 Cm Orcomplex Closure Of Laceration Vestibule Of Mouth Over 2.5 Cm Or |
| 40840-CPT | High | Surgery On Mouth Opening, Surgery To Enlarge The Opening Of The Mouth And Build Up The Bony Ridge That Holds The Gums And Teeth (Alveolar Process). |
| 40842-CPT | High | Surgery On Mouth Opening, Surgery To Enlarge The Opening Of The Mouth And Build Up The Bony Ridge That Holds The Gums And Teeth (Alveolar Process). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40831. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40831 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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