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CPT code 40899: Unlisted mouth procedure, oral vestibule2026 Medicare rate & RVUs

Reports an unlisted procedure involving the oral vestibule when no listed CPT code describes the work; Medicare payment is set by the contractor per claim.

CMS RVU26DEffective Oct 1, 2026109 payment localities114 Medicare services in 2024

Medicare rate · 40899

Unlisted mouth procedure, oral vestibule

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
YYY

National rate · 2026

—

Not priced in the facility setting.

See every locality for 40899 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 40899 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 40899 covers

CPT 40899 is an unlisted procedure code for work involving the vestibule of the mouth when no listed CPT code describes the service. The oral vestibule is the space between the lips or cheeks and the teeth or gums. The code does not identify a particular technique or diagnosis, so the claim description should explain the procedure performed. Oral and maxillofacial surgeons and other clinicians performing oral procedures may report it. Before selecting it, compare the work with specific codes for services such as biopsy, lesion excision, or mouth reconstruction.

Medicare assigns physician fee schedule status C, or carrier priced: CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. The contractor also sets the global period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50% under the stated Medicare multiple-procedure rule. Include claim details and clinical documentation that explain the unlisted service.

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 40899 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

40899 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

40899 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.

View every state and territory as a table
40899 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 40899 rate is calculated

Each of 40899’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 · 40899

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

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

Payment rules and modifiers for 40899

The CMS indicators that decide how 40899 is paid alongside other services.

CMS payment indicators · 40899

Unlisted mouth procedure, oral vestibule

RuleCMS valueWhat it means
Global periodYYYThe Medicare contractor sets the global period.
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)1Permitted with supporting documentation.
Team surgery (66)1Permitted with supporting documentation.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

40899 without 51 · national facility

$0.00

Unlisted mouth procedure, oral vestibule

40899-51 · Second procedure: 50%

$0.00

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

40899 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 40899

    Unlisted mouth procedure, oral vestibule0 wRVU

    Not priced

  • 40808

    Mouth biopsy, oral vestibule1.02 wRVU

    $168.01

  • 40810

    Mouth lesion excision, without repair1.33 wRVU

    $216.10

  • 40819

    Frenum excision, lip or cheek fold2.45 wRVU

    $276.89

  • 40840

    Mouth reconstruction, anterior vestibuloplasty8.92 wRVU

    $883.45

How to choose

40808Mouth biopsyOral vestibule
40808 is the listed biopsy code for a mouth lesion. Use 40899 only when the procedure is not described by that or another specific code.
40810Mouth lesion excisionWithout repair
40810 is a listed excision code for a mouth lesion. Consider 40899 only when no listed code describes the work performed.
40819Frenum excisionLip or cheek fold
40819 is for excision of a lip or cheek fold. It is not a general substitute for other unlisted mouth procedures.
40840Mouth reconstructionAnterior vestibuloplasty
40840 is a listed mouth reconstruction code. Use it when its described service fits; reserve 40899 for work without a matching listed code.

Codes related to 40899

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

Codes related to 40899
CodeHow it relatesNational office range
Used instead
40808Mouth biopsy, oral vestibuleListed biopsy code for a mouth lesion; use when its service matches.$147.51–$226.72
40810Mouth lesion excision, without repairListed excision code for a mouth lesion; use when its service matches.$189.83–$291.43
40819Frenum excision, lip or cheek foldListed code for excision of a lip or cheek fold.$246.29–$363.94
40840Mouth reconstruction, anterior vestibuloplastyListed mouth reconstruction code; use when its service matches.$785.27–$1,133.87

40899 billing questions

When should I use 40899 instead of a listed mouth procedure code?

Use 40899 when no listed CPT code describes the procedure performed. For a defined service such as biopsy, lesion excision, or mouth reconstruction, use the specific code when it fits.

Can I report 40899 for a mouth-lesion biopsy?

40808 is the listed biopsy code for a mouth lesion. Use 40899 only when that or another specific code does not describe the procedure.

What documentation should accompany 40899?

Describe the procedure performed and include supporting clinical documentation, such as the operative report when applicable, so the Medicare contractor can evaluate the unlisted service.

How does Medicare price 40899?

It has physician fee schedule status C. CMS publishes no national payment; the Medicare Administrative Contractor sets payment for each claim.

Who sets the global period for 40899?

The Medicare contractor sets the global period for this code.

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

Open CMS sourceHow we calculate rates

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