How much does Medicare pay for CPT 40490?

Medicare allowed an average of $110.56 per service and paid $82.35 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $231.23, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 40490?

Biopsy of lip. It was billed 2,668 times to 2,481 Medicare beneficiaries by 140 providers in 2024.

Does 40490 pay differently in an office than a hospital?

Yes. The allowed amount averaged $110.79 in an office setting and $70.57 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 40490 most?

Dermatology, with 2,235 services from 114 clinicians. Next are Physician Assistant, Nurse Practitioner, Micrographic Dermatologic Surgery.

CPT 40490

Biopsy of lip

$110.56Medicare-allowed amount per service, averaged across 2,668 services

Providers submitted

$231.23

Asking price, not received

Medicare allowed

$110.56

The fee schedule figure

Medicare paid

$82.35

Balance is patient coinsurance

Providers submitted an average of $231.23 for this code and Medicare allowed $110.56 — 2.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $82.35 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $110.79
Hospital / facility: $70.57

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 2,653 services were billed in an office setting and 15 in a facility.

Services: 2,668
Beneficiaries: 2,481
Providers billing it: 140
Total allowed: $294,974

What Medicare pays for CPT 40490

Across 2,668 services billed by 140 providers to 2,481 beneficiaries, Medicare allowed an average of $110.56 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 40490

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	2,235	2,079	$112.80	114
Physician Assistant	157	147	$98.92	9
Nurse Practitioner	133	123	$98.32	9
Micrographic Dermatologic Surgery	52	46	$102.86	3
General Practice	31	29	$96.09	1
Plastic and Reconstructive Surgery	29	27	$106.87	2
Oral Surgery (Dentist only)	16	16	$111.47	1
Otolaryngology	15	14	$70.57	1

40490 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	785	$111.60	$80.58	41
New York	364	$119.77	$80.09	14
California	256	$127.05	$80.89	16
South Carolina	249	$85.89	$67.98	6
Texas	124	$116.33	$83.72	9
Kentucky	84	$99.82	$84.90	4
Arizona	80	$113.49	$87.87	5
New Jersey	74	$115.64	$75.20	4
Tennessee	64	$101.08	$82.91	3
Pennsylvania	63	$128.18	$91.62	5
Illinois	60	$120.94	$85.50	4
Mississippi	59	$90.53	$72.25	3
Georgia	58	$105.97	$76.74	4
Massachusetts	42	$100.42	$76.08	3
North Carolina	41	$107.14	$76.37	3
Nebraska	40	$106.94	$77.43	2
Kansas	39	$113.62	$89.48	2
New Mexico	38	$102.32	$82.48	2
Indiana	27	$99.71	$75.90	2
Maryland	24	$111.49	$77.97	2
Ohio	21	$105.03	$70.88	1
Delaware	18	$103.10	$78.09	1
Virginia	16	$103.38	$80.95	1
Alabama	14	$95.05	$76.08	1
Louisiana	14	$111.51	$74.23	1
Arkansas	14	$68.20	$61.18	1

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.