2025 CPT code 40899
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Vestibule of Mouth Surgery Feed
Unlisted procedure, vestibule of mouth.
Modifiers are applicable.Common modifiers include 22 (Increased Procedural Services), 52 (Reduced Services), 53 (Discontinued Procedure) and others relevant to the specific situation.
Medical necessity must be clearly documented. This includes a description of the patient's condition necessitating the procedure, and how the procedure will address the condition. It must be established that less invasive or alternative procedures have been considered or are not appropriate.
The provider performs a surgical procedure in the vestibule of the mouth not otherwise described by a specific CPT code.
In simple words: This code is used for billing a procedure done inside your mouth, in the area between your cheeks/lips and your teeth, when there isn't a specific code for that procedure.
This code is used for reporting any procedure performed on the vestibule of the mouth that does not have a specific CPT code. The vestibule of the mouth refers to the area between the teeth and the inner lining of the cheeks and lips.
Example 1: A patient presents with a benign lesion of unusual size and location in the vestibule of the mouth requiring a complex excision not adequately described by other codes.Code 40899 would be appropriate., A surgeon performs a novel reconstructive procedure of the vestibule following traumatic injury where no specific code exists.Code 40899 is reported., A biopsy of an unusual growth in the buccal vestibule is performed, and there's no appropriate CPT code describing the specific technique or approach used for the biopsy. Code 40899 is used.
Detailed operative report describing the procedure performed, including the indication, technique, instruments used, and any unusual circumstances encountered. Documentation supporting medical necessity. Pre- and post-operative diagnoses should be clearly documented.
** Always verify payer-specific guidelines regarding the usage and reimbursement policies for unlisted CPT codes. Check for any LCDs (Local Coverage Determinations) from your MAC (Medicare Administrative Contractor) for additional information.
- Revenue Code: P1G - Major Procedure - Other
- Global Days: 090
- Payment Status: Active
- Modifier TC rule: This code represents the surgical procedure itself and includes both the technical and professional components. Specific modifiers may be applicable depending on the circumstances.
- Fee Schedule: As an unlisted code, 40899 does not have a set fee schedule.Reimbursement is determined by individual payers and often requires supporting documentation justifying the billed amount.
- Specialties:Oral Surgery, Maxillofacial Surgery, Plastic Surgery, Otolaryngology, General Dentistry
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department, Physician's Office