$105.68–$118.70
40806 is for incising the labial frenum to release it. Choose 40819 when the fold itself is surgically excised.
On this page
CMS RVU26D · Effective 2026-10-01
40819 Frenum excision Medicare reimbursement rates in Massachusetts
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. Compare 40819 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 40819 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
$286.23–$315.35
2 of 2 localities have a supported rate.
Facility setting
$193.38–$210.06
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 40819: Excision of lip or cheek frenum
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.
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.
CMS billing rules for 40819
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are 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 RVU2.45 · 30%
- Practice expense (office) RVU5.57 · 67%
- Malpractice RVU0.27 · 3%
64
Medicare services in 2024 · #5200 by national volume
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.
40819 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
$224.37–$249.40
40810 addresses excision of a vestibular mucosal lesion without repair. Use 40819 when the surgical target is the lip or cheek fold.
$290.81–$321.05
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.
Compare 40819 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
$315.35
Facility
$210.06
Rest Of Massachusetts →
Office / nonfacility
$286.23
Facility
$193.38
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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 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.
4,86540814,,Excise/repair mouth lesion,A,,3.43,7.57,,4.05,,0.44,11.44,7.92,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86640816,,Excision of mouth lesion,A,,3.68,8.06,,4.21,,0.49,12.23,8.38,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86740818,,Excise oral mucosa for graft,A,,2.76,7.80,,4.27,,0.35,10.91,7.38,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86840819,,Excise lip or cheek fold,A,,2.45,5.57,,2.93,,0.27,8.29,5.65,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86940820,,Treatment of mouth lesion,A,,1.31,6.09,,3.13,,0.15,7.55,4.59,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,87040830,,Repair mouth laceration,A,,1.77,4.94,,2.15,,0.23,6.94,4.15,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,87140831,,Repair mouth laceration,A,,2.51,6.51,,2.94,,0.34,9.36,5.79,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00