CPT 40806 Surgery - Digestive
Incision of lip fold Cost
Body System: Digestive
Medicare Facility Rate
$29
CMS PFS CY2026
Medicare Non-Facility Rate
$101
Office/clinic setting
Hospital Outpatient
$551
OPPS rate
Surgery Center (ASC)
$90
ASC rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
0.30
Work RVU
0.50
Facility PE RVU
0.06
Malpractice RVU
3.03
Total RVU
Frequently Asked Questions
How much does Incision of lip fold cost?
The Medicare facility rate is $29. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $551. Ambulatory surgery center rate: $90.
How much does Incision of lip fold cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $29.