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CPT code 40819: Frenum excision, lip or cheek fold2026 Medicare rate & RVUs in Vermont

Reports surgical removal of a lip or cheek fold, commonly a labial or buccal frenum, when the fold itself is excised rather than simply released.

CMS RVU26DEffective Oct 1, 2026One payment locality64 Medicare services in 2024

In Vermont, Medicare pays $270.58 for 40819 in the office and $183.28 when it’s performed in a hospital or facility.

$270.58Office (non-facility)
$183.28Hospital or facility
−2.3%vs the national office rate ($276.89)

Check a contract rate as a % of Medicare · 40819 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 40819 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Vermont
  2. What 40819 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 40819 covers

Code 40819 represents surgical removal of a lip or cheek fold, commonly a labial or buccal frenum, rather than release by incision alone. An oral and maxillofacial surgeon, oral surgeon, or other qualified surgeon may perform it for a restrictive or symptomatic fold in the oral vestibule. The operative note should identify the fold and site, explain the reason for excision, and describe the tissue removed.

Select this code when the fold itself is excised; a simple frenum incision is a different service, and a discrete mucosal lesion is coded according to the lesion procedure performed. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. 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 Vermont compares for 40819

Across 109 of 109 payment localities, the office rate for 40819 runs from $246.29 in Arkansas to $363.94 in San Benito County, CA. Vermont pays $270.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

40819 in Vermont vs other payment areas
  1. Vermont · this page$270.58
  2. Los Angeles, CA · California$311.26+$40.68
  3. Washington, DC area · District of Columbia$315.45+$44.87
  4. Miami, FL · Florida$298.31+$27.73
  5. Chicago, IL · Illinois$290.08+$19.50
  6. Manhattan, NY · New York$317.55+$46.97
  7. Alaska · Alaska$325.85+$55.27

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

Every other payment area

40819 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$249.72$172.57
ArkansasArkansas$246.29$170.54
ArizonaArizona$269.83$184.38
Bakersfield, CACalifornia$292.78$196.14
Chico, CACalifornia$291.96$195.32
El Centro, CACalifornia$292.01$195.36
Fresno, CACalifornia$291.96$195.32
Hanford, CACalifornia$291.96$195.32

40819 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.

$246.29

$327.95

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

View every state and territory as a table
40819 office rate range by state
State / territoryOffice rate rangeLocalities
AK$325.851
AL$249.721
AR$246.291
AZ$269.831
CA$291.96–$363.9429
CO$287.811
CT$294.751
DC$315.451
DE$274.161
FL$273.24–$298.313
GA$258.53–$281.932
GU$298.581
HI$298.581
IA$255.641
ID$257.261
IL$265.78–$290.084
IN$258.681
KS$254.561
KY$255.481
LA$255.12–$267.142
MA$286.23–$315.352
MD$279.20–$315.453
ME$258.60–$271.892
MI$261.87–$276.572
MN$275.941
MO$250.99–$267.983
MS$248.681
MT$276.881
NC$261.171
ND$271.541
NE$256.961
NH$283.391
NJ$298.16–$312.432
NM$263.261
NV$275.571
NY$264.91–$325.025
OH$260.781
OK$254.981
OR$273.47–$296.542
PA$261.14–$287.732
PR$278.801
RI$283.611
SC$261.401
SD$270.911
TN$255.791
TX$259.51–$286.828
UT$264.811
VA$271.08–$315.452
VI$278.801
VT$270.581
WA$285.66–$321.572
WI$262.841
WV$256.411
WY$274.551

See 40819 in every payment locality

How the 40819 rate is calculated

Each of 40819’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 · 40819

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.45

2.45 RVUs× 1.000 GPCI

Practice expense5.57

5.57 RVUs× 1.000 GPCI

Malpractice0.27

0.27 RVUs× 1.000 GPCI

Adjusted RVUs

8.2900

Conversion factor

$33.4009

Medicare rate

$276.89

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Vermont inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,868

Code
40819
Physician work
2.45
Practice expense
5.57
Malpractice
0.27

GPCI2026.csv

105

Locality
Vermont
Physician work
1.000
Practice expense
0.990
Malpractice
0.506
Office calculation for 40819 in Vermont
ComponentRVULocality factorAdjusted
Physician work2.45× 1.0002.4500
Practice expense5.57× 0.9905.5143
Malpractice0.27× 0.5060.1366
Total RVUs8.1009
Conversion factor× 33.4009

Office rate, Vermont$270.58

Office: (2.45 × 1 + 5.57 × 0.99 + 0.27 × 0.506) × $33.4009 = $270.58

Facility: (2.45 × 1 + 2.93 × 0.99 + 0.27 × 0.506) × $33.4009 = $183.28

Open 40819 in the RVU calculator

Payment rules and modifiers for 40819

40819 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40819

Frenum excision, lip or cheek fold

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are 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.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 40819

Frenum excision, lip or cheek fold

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

40819 without 51 · national office

$276.89

Frenum excision, lip or cheek fold

40819-51 · Second procedure: 50%

$138.45

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 40819

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

Codes related to 40819
CodeHow it relatesOffice range, Vermont
Used instead
40806Lip frenum release, labial frenumFrenum incision is used for release without excision of the fold.$99.32
40810Mouth lesion excision, without repairFor excision of a vestibular mucosal lesion without repair, rather than fold excision.$211.48
40812Oral lesion excision, simple repairFor excision of a vestibular mucosal lesion with simple repair, rather than fold excision.$274.51

How 40819 has changed in Vermont

40819 · Office / nonfacility

$270.58

Effective 2026-10-01

The base rate is $10.16 higher than on 2025-10-01, moving from $260.42 to $270.58 (3.9%).

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

    $260.42changed to$270.58

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.51 changed to 2.45
    • Practice expense RVU 5.46 changed to 5.57
    • Malpractice RVU 0.23 changed to 0.27
    • Practice expense GPCI 0.993 changed to 0.990
    • Malpractice GPCI 0.518 changed to 0.506

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $265.19changed to$260.42

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.37 changed to 5.46
    • Malpractice RVU 0.24 changed to 0.23

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $260.86changed to$265.19

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $269.37changed to$260.86

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.33 changed to 5.37
    • Malpractice RVU 0.23 changed to 0.24
    • Practice expense GPCI 0.997 changed to 0.993
    • Malpractice GPCI 0.543 changed to 0.518

  5. January 1, 2023

    RVU23A

    $274.79changed to$269.37

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.30 changed to 5.33
    • Malpractice RVU 0.22 changed to 0.23
    • Practice expense GPCI 1.001 changed to 0.997
    • Malpractice GPCI 0.569 changed to 0.543

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $280.71changed to$274.79

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.41 changed to 5.30
    • Malpractice RVU 0.21 changed to 0.22

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $289.10changed to$280.71

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.33 changed to 5.41
    • Malpractice RVU 0.22 changed to 0.21
    • Practice expense GPCI 1.008 changed to 1.001
    • Malpractice GPCI 0.582 changed to 0.569

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $323.48changed to$289.10

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 6.13 changed to 5.33
    • Malpractice RVU 0.41 changed to 0.22
    • Practice expense GPCI 1.015 changed to 1.008
    • Malpractice GPCI 0.595 changed to 0.582

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $326.78changed to$323.48

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.23 changed to 6.13

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $326.39changed to$326.78

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.26 changed to 6.23
    • Practice expense GPCI 1.010 changed to 1.015
    • Malpractice GPCI 0.639 changed to 0.595

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $327.56changed to$326.39

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 6.32 changed to 6.26
    • Malpractice RVU 0.43 changed to 0.41
    • Practice expense GPCI 1.004 changed to 1.010
    • Malpractice GPCI 0.682 changed to 0.639

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $325.72changed to$327.56

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 6.25 changed to 6.32
    • Malpractice RVU 0.41 changed to 0.43

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $324.10changed to$325.72

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $319.71changed to$324.10

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.18 changed to 6.25
    • Malpractice RVU 0.32 changed to 0.41
    • Practice expense GPCI 1.006 changed to 1.004
    • Malpractice GPCI 0.618 changed to 0.682

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$319.71

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$270.58$183.28RVU26D
2026-07-01$270.58$183.28RVU26C
2026-04-01$270.58$183.28RVU26B
2026-01-01$270.58$183.28RVU26A
2025-10-01$260.42$193.93RVU25D
2025-07-01$260.42$193.93RVU25C
2025-04-01$260.42$193.93RVU25B
2025-01-01$260.42$193.93RVU25A
2024-10-01$265.19$195.45RVU24D
2024-07-01$265.19$195.45RVU24C
2024-04-01$265.19$195.45RVU24B
2024-03-09$265.19$195.45RVU24AR
2024-01-01$260.86$192.26RVU24A
2023-10-01$269.37$197.06RVU23D
2023-07-01$269.37$197.06RVU23C
2023-04-01$269.37$197.06RVU23B
2023-01-01$269.37$197.06RVU23A
2022-10-01$274.79$198.93RVU22D
2022-07-01$274.79$198.93RVU22C
2022-04-01$274.79$198.93RVU22B
2022-01-01$274.79$198.93RVU22A
2021-10-01$280.71$203.17RVU21D
2021-07-01$280.71$203.17RVU21C
2021-04-01$280.71$203.17RVU21B
2021-01-01$280.71$203.17RVU21A
2020-10-01$289.10$216.71RVU20D
2020-07-01$289.10$216.71RVU20C
2020-04-01$289.10$216.71RVU20B
2020-01-01$289.10$216.71RVU20A
2019-10-01$323.48$240.81RVU19D
2019-07-01$323.48$240.81RVU19C
2019-04-01$323.48$240.81RVU19B
2019-01-01$323.48$240.81RVU19A
2018-10-01$326.78$246.76RVU18D
2018-07-01$326.78$246.76RVU18C
2018-04-01$326.78$246.76RVU18B
2018-01-01$326.78$246.76RVU18AR1
2017-10-01$326.39$248.10RVU17D
2017-07-01$326.39$248.10RVU17C
2017-04-01$326.39$248.10RVU17B
2017-01-01$326.39$248.10RVU17A
2016-10-01$327.56$249.19RVU16D
2016-07-01$327.56$249.19RVU16C
2016-04-01$327.56$249.19RVU16B
2016-01-01$327.56$249.19RVU16A
2015-10-01$325.72$247.44RVU15D
2015-07-01$325.72$247.44RVU15C
2015-04-01$324.10$246.20RVU15B
2015-01-01$324.10$246.20RVU15A
2014-10-01$319.71$242.95RVU14D
2014-07-01$319.71$242.95RVU14C
2014-04-01$319.71$242.95RVU14B
2014-01-01$319.71$242.95RVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 40819 for an earlier date of service

Where the Vermont rate applies

Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.

  • Albany
  • Alburgh
  • Algiers
  • Arlington
  • Ascutney
  • Bakersfield
  • Barnet
  • Barre

Browse all communities in Vermont

40819 billing questions

How is excision different from a frenum incision?

Use 40819 when the lip or cheek fold is excised. Code 40806 describes an incision of the labial frenum, not excision of the fold.

Should modifier 50 be reported for folds on both sides?

No. Modifier 50 is inappropriate for 40819 under the CMS bilateral rule.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.

Can an assistant surgeon be paid for this procedure?

Assistant-at-surgery payment is available only when the medical necessity of the assistant is documented.

Can co-surgeons or a surgical team report this service?

CMS does not permit co-surgeons or team surgery for 40819.

When should a mouth-lesion excision code be considered instead?

When the operative target is a discrete mucosal lesion rather than the lip or cheek fold, select the lesion-excision code that matches the documented procedure and repair.

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 40819PPRRVU2026_Oct_nonQPP.csv, line 4,868 (RVU26D)
Geographic factors for VermontGPCI2026.csv, line 105 (RVU26D)

Open CMS sourceHow we calculate rates

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