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CPT code 40806: Lip frenum release, labial frenum2026 Medicare rate & RVUs in Manhattan, NY

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 Manhattan, NY, Medicare pays $117.47 for 40806 in the office and $33.25 when it’s performed in a hospital or facility.

$117.47Office (non-facility)
$33.25Hospital or facility
+16.1%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 Manhattan, NY
  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 Manhattan, NY 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. Manhattan, NY pays $117.47. The RVUs are the same everywhere; the geographic indexes change the dollars.

40806 in Manhattan, NY vs other payment areas
  1. Manhattan, NY · this page$117.47
  2. NYC suburbs and Long Island, NY · New York$120.42+$2.95
  3. Poughkeepsie and northern NYC suburbs, NY · New York$110.55−$6.92
  4. Queens, NY · New York$118.96+$1.49
  5. Rest of New York · New York$96.15−$21.32
  6. Los Angeles, CA · California$117.26−$0.21
  7. Washington, DC area · District of Columbia$117.85+$0.38

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

40806 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$107.93$32.47
Chicago, ILIllinois$104.32$31.47
AlaskaAlaska$111.11$33.92
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

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 Manhattan, NY 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

78

Locality
Manhattan, NY
Physician work
1.064
Practice expense
1.162
Malpractice
1.586
Office calculation for 40806 in Manhattan, NY
ComponentRVULocality factorAdjusted
Physician work0.30× 1.0640.3192
Practice expense2.67× 1.1623.1025
Malpractice0.06× 1.5860.0952
Total RVUs3.5169
Conversion factor× 33.4009

Office rate, Manhattan, NY$117.47

Office: (0.3 × 1.064 + 2.67 × 1.162 + 0.06 × 1.586) × $33.4009 = $117.47

Facility: (0.3 × 1.064 + 0.5 × 1.162 + 0.06 × 1.586) × $33.4009 = $33.25

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, Manhattan, NY
Same family
40819Frenum excision, lip or cheek foldRelated lip or cheek fold procedure; this code describes excision rather than frenum incision and release.$317.55
41115Tongue-tie surgery, lingual frenum excisionFrenum procedure involving the tongue rather than the labial frenum.$295.11
41520Frenuloplasty, for restricted tongue movementFrenuloplasty involving the lingual frenum, not the labial frenum.$416.19

How 40806 has changed in Manhattan, NY

40806 · Office / nonfacility

$117.47

Effective 2026-10-01

The base rate is $4.32 higher than on 2025-10-01, moving from $113.15 to $117.47 (3.8%).

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

    $113.15changed to$117.47

    • 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
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.166 changed to 1.162
    • Malpractice GPCI 1.656 changed to 1.586

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $116.21changed to$113.15

    • 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

    $114.32changed to$116.21

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $119.57changed to$114.32

    • Conversion factor 33.8872 changed to 32.7442
    • Malpractice RVU 0.04 changed to 0.05
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.184 changed to 1.166
    • Malpractice GPCI 1.843 changed to 1.656

  5. January 1, 2023

    RVU23A

    $123.63changed to$119.57

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.63 changed to 2.64
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.203 changed to 1.184
    • Malpractice GPCI 2.031 changed to 1.843

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $126.33changed to$123.63

    • 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

    $121.77changed to$126.33

    • 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
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.192 changed to 1.203
    • Malpractice GPCI 1.823 changed to 2.031

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $123.42changed to$121.77

    • 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
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.180 changed to 1.192
    • Malpractice GPCI 1.615 changed to 1.823

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $126.26changed to$123.42

    • 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

    $127.00changed to$126.26

    • 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
    • Practice expense GPCI 1.174 changed to 1.180
    • Malpractice GPCI 1.690 changed to 1.615

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $136.94changed to$127.00

    • 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 1.168 changed to 1.174
    • Malpractice GPCI 1.764 changed to 1.690

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $131.15changed to$136.94

    • 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

    $130.49changed to$131.15

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $158.31changed to$130.49

    • 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
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.165 changed to 1.168
    • Malpractice GPCI 1.518 changed to 1.764

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $140.63changed to$158.31

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.23 changed to 3.46
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.162 changed to 1.165
    • Malpractice GPCI 1.271 changed to 1.518

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $140.63

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$117.47$33.25RVU26D
2026-07-01$117.47$33.25RVU26C
2026-04-01$117.47$33.25RVU26B
2026-01-01$117.47$33.25RVU26A
2025-10-01$113.15$33.94RVU25D
2025-07-01$113.15$33.94RVU25C
2025-04-01$113.15$33.94RVU25B
2025-01-01$113.15$33.94RVU25A
2024-10-01$116.21$34.32RVU24D
2024-07-01$116.21$34.32RVU24C
2024-04-01$116.21$34.32RVU24B
2024-03-09$116.21$34.32RVU24AR
2024-01-01$114.32$33.76RVU24A
2023-10-01$119.57$34.11RVU23D
2023-07-01$119.57$34.11RVU23C
2023-04-01$119.57$34.11RVU23B
2023-01-01$119.57$34.11RVU23A
2022-10-01$123.63$34.12RVU22D
2022-07-01$123.63$34.12RVU22C
2022-04-01$123.63$34.12RVU22B
2022-01-01$123.63$34.12RVU22A
2021-10-01$126.33$34.41RVU21D
2021-07-01$126.33$34.41RVU21C
2021-04-01$126.33$34.41RVU21B
2021-01-01$126.33$34.41RVU21A
2020-10-01$121.77$37.02RVU20D
2020-07-01$121.77$37.02RVU20C
2020-04-01$121.77$37.02RVU20B
2020-01-01$121.77$37.02RVU20A
2019-10-01$123.42$39.22RVU19D
2019-07-01$123.42$39.22RVU19C
2019-04-01$123.42$39.22RVU19B
2019-01-01$123.42$39.22RVU19A
2018-10-01$126.26$41.30RVU18D
2018-07-01$126.26$41.30RVU18C
2018-04-01$126.26$41.30RVU18B
2018-01-01$126.26$41.30RVU18AR1
2017-10-01$127.00$40.20RVU17D
2017-07-01$127.00$40.20RVU17C
2017-04-01$127.00$40.20RVU17B
2017-01-01$127.00$40.20RVU17A
2016-10-01$136.94$38.66RVU16D
2016-07-01$136.94$38.66RVU16C
2016-04-01$136.94$38.66RVU16B
2016-01-01$136.94$38.66RVU16A
2015-10-01$131.15$40.49RVU15D
2015-07-01$131.15$40.49RVU15C
2015-04-01$130.49$40.29RVU15B
2015-01-01$130.49$40.29RVU15A
2014-10-01$158.31$41.87RVU14D
2014-07-01$158.31$41.87RVU14C
2014-04-01$158.31$41.87RVU14B
2014-01-01$158.31$41.87RVU14A
2013-10-01$140.63$37.05RVU13D
2013-07-01$140.63$37.05RVU13C
2013-04-01$140.63$37.05RVU13B
2013-01-01$140.63$37.05RVU13AR

Price 40806 for an earlier date of service

Where the Manhattan, NY rate applies

Manhattan, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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 Manhattan, NYGPCI2026.csv, line 78 (RVU26D)

Open CMS sourceHow we calculate rates

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