$286.23–$315.35
Use 40806 for incision and release of a labial frenum. Use 40819 when the service is excision of a lip or cheek fold.
On this page
CMS RVU26D · Effective 2026-10-01
40806 Lip frenum release Medicare reimbursement rates in Massachusetts
Report this service for incision and release of a restrictive labial frenum, the tissue fold connecting the inner lip to the gum. Compare 40806 office and facility rates across CMS payment localities in Massachusetts.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 40806 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$105.68–$118.70
2 of 2 localities have a supported rate.
Facility setting
$29.36–$32.16
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Oral surgery
About 40806: Labial frenum incision and release
Report this service for incision and release of a restrictive labial frenum, the tissue fold connecting the inner lip to the gum.
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.
CMS billing rules for 40806
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.30 · 10%
- Practice expense (office) RVU2.67 · 88%
- Malpractice RVU0.06 · 2%
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.
40806 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
$265.11–$294.00
41115 concerns the lingual frenum beneath the tongue; 40806 concerns the frenum joining the inner lip to the gum.
$174.45–$193.97
40808 is for biopsy of a mouth lesion to obtain tissue for diagnosis. It is not the code for releasing a restrictive labial frenum.
Compare 40806 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
$118.70
Facility
$32.16
Rest Of Massachusetts →
Office / nonfacility
$105.68
Facility
$29.36
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,85840801,,Drainage of mouth lesion,A,,2.56,6.30,,2.77,,0.34,9.20,5.67,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,85940804,,Removal foreign body mouth,A,,1.27,4.80,,2.00,,0.19,6.26,3.46,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86040805,,Removal foreign body mouth,A,,2.72,5.71,,2.49,,0.30,8.73,5.51,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86140806,,Incision of lip fold,A,,0.30,2.67,,0.50,,0.06,3.03,0.86,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86240808,,Biopsy of mouth lesion,A,,1.02,3.87,,1.31,,0.14,5.03,2.47,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86340810,,Excision of mouth lesion,A,,1.33,4.96,,1.93,,0.18,6.47,3.44,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86440812,,Excise/repair mouth lesion,A,,2.31,5.82,,2.44,,0.29,8.42,5.04,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00