Billing code 40819: Frenum excisionMedicare rate & RVUs

Medicare pays $276.89 for 40819 nationally in the office and $188.72 in a hospital or facility. Local office rates run $246.29–$363.94.

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

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.

Where 40819 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

40819 rates by state

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

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.

Payment rules and modifiers for 40819

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

What modifiers do to the payment

When to use modifier 51

40819 compared with similar codes

How to choose

40806Lip frenum release

40806 is for incising the labial frenum to release it. Choose 40819 when the fold itself is surgically excised.

40810Mouth lesion excision

40810 addresses excision of a vestibular mucosal lesion without repair. Use 40819 when the surgical target is the lip or cheek fold.

40812Oral lesion excision

40812 is for mucosal lesion excision with simple repair. It is not the fold-excision code when the frenum or lip or cheek fold is the target.

Codes related to 40819

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

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