CPT code 40806: Lip frenum release, labial frenum2026 Medicare rate & RVUs in California
Report this service for incision and release of a restrictive labial frenum, the tissue fold connecting the inner lip to the gum.
Medicare pays $109.01–$140.79 for 40806 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 40806 covers
This procedure releases a restrictive labial frenum by incising the tissue fold between the inner surface of the upper or lower lip and the gum. It may be performed by an oral surgeon, dentist, or other qualified clinician when the labial attachment is being released; it is distinct from surgery on the lingual frenum beneath the tongue. The record should identify the lip site and describe the frenum release performed.
Select this code for incision and release, not for removal of a mouth lesion or excision of a lip or cheek fold. Document the clinical indication, anatomical site, and work performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 40806 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$109.01 to $140.79
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $109.17 | $29.73 |
| Chico, CA | $109.01 | $29.57 |
| El Centro, CA | $109.02 | $29.58 |
| Fresno, CA | $109.01 | $29.57 |
| Hanford, CA | $109.01 | $29.57 |
| Los Angeles, CA | $117.26 | $31.52 |
| Madera, CA | $109.01 | $29.57 |
| Marin County, CA | $137.64 | $35.44 |
| Merced, CA | $109.01 | $29.57 |
| Modesto, CA | $109.01 | $29.57 |
| Napa, CA | $129.21 | $33.68 |
| Oxnard, CA | $116.96 | $31.29 |
| Redding, CA | $109.01 | $29.57 |
| Rest of California | $109.01 | $29.57 |
| Riverside, CA | $109.65 | $30.21 |
| Sacramento, CA | $115.17 | $30.88 |
| Salinas, CA | $114.77 | $30.76 |
| San Benito County, CA | $140.79 | $36.28 |
| San Diego, CA | $118.07 | $31.38 |
| San Francisco, CA | $137.57 | $35.37 |
| San Luis Obispo, CA | $112.84 | $30.29 |
| Santa Clara County, CA | $140.52 | $36.00 |
| Santa Cruz, CA | $119.66 | $31.60 |
| Santa Maria, CA | $115.36 | $30.85 |
| Santa Rosa, CA | $120.91 | $31.90 |
| Stockton, CA | $109.01 | $29.57 |
| Vallejo, CA | $129.11 | $33.58 |
| Visalia, CA | $109.01 | $29.57 |
| Yuba City, CA | $109.01 | $29.57 |
How the 40806 rate is calculated
Each of 40806’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 40806
RVUs × geographic indexes × conversion factor
Work0.30
0.30 RVUs× 1.000 GPCI
Practice expense2.67
2.67 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
3.0300
Conversion factor
$33.4009
Medicare rate
$101.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40806
The CMS indicators that decide how 40806 is paid alongside other services.
CMS payment indicators · 40806
Lip frenum release, labial frenum
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
40806 without 51 · national office
$101.20
Lip frenum release, labial frenum
40806-51 · Second procedure: 50%
$50.60
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
40806 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 40819Frenum excisionLip or cheek fold
- Use 40806 for incision and release of a labial frenum. Use 40819 when the service is excision of a lip or cheek fold.
- 41115Tongue-tie surgeryLingual frenum excision
- 41115 concerns the lingual frenum beneath the tongue; 40806 concerns the frenum joining the inner lip to the gum.
- 40808Mouth biopsyOral vestibule
- 40808 is for biopsy of a mouth lesion to obtain tissue for diagnosis. It is not the code for releasing a restrictive labial frenum.
40806 billing questions
How does this differ from a lingual frenum procedure?
This code is for incision and release of a labial frenum connecting the inner lip to the gum. Procedures on the frenum beneath the tongue are coded separately.
When would 40819 be more appropriate?
Choose 40819 when the documented service is excision of a lip or cheek fold. This code describes incision and release of a labial frenum.
Should modifier 50 be appended for upper and lower lip sites?
No. CMS identifies bilateral adjustment as inappropriate for this code. Document the treated site or sites without using modifier 50.
What documentation supports reporting this code?
Document the restrictive labial frenum, whether it is associated with the upper or lower lip, the clinical reason for release, and the incision and release performed.
How does the 0-day global period affect same-day services?
Same-day preoperative and postoperative care is included in the procedure. If other procedures occur in the same session, the standard multiple procedure reduction applies.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
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