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CPT code 40806: Lip frenum release, labial frenum2026 Medicare rate & RVUs in North Carolina

Report this service for incision and release of a restrictive labial frenum, the tissue fold connecting the inner lip to the gum.

CMS RVU26DEffective Oct 1, 2026One payment locality

In North Carolina, Medicare pays $94.51 for 40806 in the office and $26.88 when it’s performed in a hospital or facility.

$94.51Office (non-facility)
$26.88Hospital or facility
−6.6%vs the national office rate ($101.20)

Check a contract rate as a % of Medicare · 40806 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 40806 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 40806 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How North Carolina compares for 40806

Across 109 of 109 payment localities, the office rate for 40806 runs from $87.66 in Arkansas to $140.79 in San Benito County, CA. North Carolina pays $94.51. The RVUs are the same everywhere; the geographic indexes change the dollars.

40806 in North Carolina vs other payment areas
  1. North Carolina · this page$94.51
  2. Los Angeles, CA · California$117.26+$22.75
  3. Washington, DC area · District of Columbia$117.85+$23.34
  4. Miami, FL · Florida$107.93+$13.42
  5. Chicago, IL · Illinois$104.32+$9.81
  6. Manhattan, NY · New York$117.47+$22.96
  7. Alaska · Alaska$111.11+$16.60

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

40806 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$89.19$25.77
ArkansasArkansas$87.66$25.40
ArizonaArizona$98.15$27.92
Bakersfield, CACalifornia$109.17$29.73
Chico, CACalifornia$109.01$29.57
El Centro, CACalifornia$109.02$29.58
Fresno, CACalifornia$109.01$29.57
Hanford, CACalifornia$109.01$29.57

40806 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$87.66

$124.90

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
40806 office rate range by state
State / territoryOffice rate rangeLocalities
AK$111.111
AL$89.191
AR$87.661
AZ$98.151
CA$109.01–$140.7929
CO$106.591
CT$108.691
DC$117.851
DE$99.981
FL$98.29–$107.933
GA$91.96–$103.062
GU$112.581
HI$112.581
IA$92.421
ID$93.011
IL$94.57–$105.234
IN$93.661
KS$91.651
KY$91.141
LA$90.86–$96.222
MA$105.68–$118.702
MD$102.21–$117.853
ME$93.31–$99.662
MI$93.70–$99.462
MN$102.381
MO$88.85–$96.933
MS$88.291
MT$101.201
NC$94.511
ND$100.011
NE$93.091
NH$104.611
NJ$110.00–$116.242
NM$94.211
NV$100.961
NY$96.15–$120.425
OH$93.461
OK$91.221
OR$100.25–$110.752
PA$93.78–$105.432
PR$102.161
RI$104.121
SC$94.131
SD$99.871
TN$92.161
TX$93.04–$106.178
UT$95.651
VA$99.10–$117.852
VI$102.161
VT$99.321
WA$105.58–$121.582
WI$96.071
WV$90.391
WY$100.681

See 40806 in every payment locality

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

Office or facility?

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.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,861

Code
40806
Physician work
0.30
Practice expense
2.67
Malpractice
0.06

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 40806 in North Carolina
ComponentRVULocality factorAdjusted
Physician work0.30× 1.0000.3000
Practice expense2.67× 0.9332.4911
Malpractice0.06× 0.6390.0383
Total RVUs2.8294
Conversion factor× 33.4009

Office rate, North Carolina$94.51

Office: (0.3 × 1 + 2.67 × 0.933 + 0.06 × 0.639) × $33.4009 = $94.51

Facility: (0.3 × 1 + 0.5 × 0.933 + 0.06 × 0.639) × $33.4009 = $26.88

Open 40806 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

Codes related to 40806

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 40806
CodeHow it relatesOffice range, North Carolina
Same family
40819Frenum excision, lip or cheek foldRelated lip or cheek fold procedure; this code describes excision rather than frenum incision and release.$261.17
41115Tongue-tie surgery, lingual frenum excisionFrenum procedure involving the tongue rather than the labial frenum.$240.17
41520Frenuloplasty, for restricted tongue movementFrenuloplasty involving the lingual frenum, not the labial frenum.$339.12

How 40806 has changed in North Carolina

40806 · Office / nonfacility

$94.51

Effective 2026-10-01

The base rate is $3.95 higher than on 2025-10-01, moving from $90.56 to $94.51 (4.4%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $90.56changed to$94.51

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.31 changed to 0.30
    • Practice expense RVU 2.66 changed to 2.67
    • Malpractice RVU 0.04 changed to 0.06
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $92.80changed to$90.56

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.64 changed to 2.66
    • Malpractice RVU 0.05 changed to 0.04

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $91.29changed to$92.80

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $94.44changed to$91.29

    • Conversion factor 33.8872 changed to 32.7442
    • Malpractice RVU 0.04 changed to 0.05
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $96.32changed to$94.44

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.63 changed to 2.64
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $98.42changed to$96.32

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.67 changed to 2.63

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $95.79changed to$98.42

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.48 changed to 2.67
    • Malpractice RVU 0.05 changed to 0.04
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $97.81changed to$95.79

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.53 changed to 2.48
    • Malpractice RVU 0.07 changed to 0.05
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $100.05changed to$97.81

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.60 changed to 2.53

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $101.24changed to$100.05

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.65 changed to 2.60
    • Malpractice RVU 0.06 changed to 0.07
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $110.15changed to$101.24

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.95 changed to 2.65
    • Malpractice RVU 0.03 changed to 0.06
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $105.09changed to$110.15

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.77 changed to 2.95
    • Malpractice RVU 0.05 changed to 0.03

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $104.56changed to$105.09

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $127.30changed to$104.56

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.46 changed to 2.77
    • Malpractice RVU 0.04 changed to 0.05
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $113.36changed to$127.30

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.23 changed to 3.46
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $113.36

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$94.51$26.88RVU26D
2026-07-01$94.51$26.88RVU26C
2026-04-01$94.51$26.88RVU26B
2026-01-01$94.51$26.88RVU26A
2025-10-01$90.56$27.66RVU25D
2025-07-01$90.56$27.66RVU25C
2025-04-01$90.56$27.66RVU25B
2025-01-01$90.56$27.66RVU25A
2024-10-01$92.80$27.76RVU24D
2024-07-01$92.80$27.76RVU24C
2024-04-01$92.80$27.76RVU24B
2024-03-09$92.80$27.76RVU24AR
2024-01-01$91.29$27.31RVU24A
2023-10-01$94.44$27.53RVU23D
2023-07-01$94.44$27.53RVU23C
2023-04-01$94.44$27.53RVU23B
2023-01-01$94.44$27.53RVU23A
2022-10-01$96.32$27.28RVU22D
2022-07-01$96.32$27.28RVU22C
2022-04-01$96.32$27.28RVU22B
2022-01-01$96.32$27.28RVU22A
2021-10-01$98.42$27.50RVU21D
2021-07-01$98.42$27.50RVU21C
2021-04-01$98.42$27.50RVU21B
2021-01-01$98.42$27.50RVU21A
2020-10-01$95.79$29.67RVU20D
2020-07-01$95.79$29.67RVU20C
2020-04-01$95.79$29.67RVU20B
2020-01-01$95.79$29.67RVU20A
2019-10-01$97.81$31.38RVU19D
2019-07-01$97.81$31.38RVU19C
2019-04-01$97.81$31.38RVU19B
2019-01-01$97.81$31.38RVU19A
2018-10-01$100.05$33.02RVU18D
2018-07-01$100.05$33.02RVU18C
2018-04-01$100.05$33.02RVU18B
2018-01-01$100.05$33.02RVU18AR1
2017-10-01$101.24$32.42RVU17D
2017-07-01$101.24$32.42RVU17C
2017-04-01$101.24$32.42RVU17B
2017-01-01$101.24$32.42RVU17A
2016-10-01$110.15$31.90RVU16D
2016-07-01$110.15$31.90RVU16C
2016-04-01$110.15$31.90RVU16B
2016-01-01$110.15$31.90RVU16A
2015-10-01$105.09$32.90RVU15D
2015-07-01$105.09$32.90RVU15C
2015-04-01$104.56$32.74RVU15B
2015-01-01$104.56$32.74RVU15A
2014-10-01$127.30$34.45RVU14D
2014-07-01$127.30$34.45RVU14C
2014-04-01$127.30$34.45RVU14B
2014-01-01$127.30$34.45RVU14A
2013-10-01$113.36$30.73RVU13D
2013-07-01$113.36$30.73RVU13C
2013-04-01$113.36$30.73RVU13B
2013-01-01$113.36$30.73RVU13AR

Price 40806 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

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.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 40806PPRRVU2026_Oct_nonQPP.csv, line 4,861 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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