Billing code 40819: Frenum excisionMedicare rate & RVUs in Texas
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.
Medicare pays $259.51–$286.82 for 40819 in the office in Texas, from Beaumont to Austin. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$259.51 to $286.82
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $286.82 | $193.53 |
| Beaumont | $259.51 | $179.27 |
| Brazoria | $273.89 | $186.50 |
| Dallas | $275.61 | $187.78 |
| Fort Worth | $273.86 | $186.92 |
| Galveston | $274.69 | $187.13 |
| Houston | $279.64 | $192.08 |
| Rest Of Texas | $266.53 | $182.85 |
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
Swap in your local Medicare rate.
Work 2.45Practice expense 5.57Malpractice 0.27
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 40819
Frenum excision
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.
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
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%).
40819 compared with similar codes
Compare codes
40819 vs 40806 vs 40810 vs 40812: national Medicare rates
Swap in your local Medicare rate.
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.
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
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