CPT code 21040: Mandibular lesion excision, intraoral approach2026 Medicare rate & RVUs in North Carolina
Reports intraoral removal of a benign lesion of the mandible when the procedure requires more than routine dental extraction or simple cyst care.
In North Carolina, Medicare pays $452.74 for 21040 in the office and $319.98 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 21040 nationwide
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 11 sections
What 21040 covers
CPT 21040 describes removal of a benign tumor or cyst from the mandible through an intraoral approach. Oral and maxillofacial surgeons and other surgeons with appropriate training may perform it in an office, ambulatory surgery center, or hospital operating room. The operative work may involve incising oral mucosa, exposing the mandibular lesion, removing it, and closing the site. The code is for a benign lesion, not a malignant jaw tumor or an exostosis.
Select the code based on the documented lesion, mandibular site, and intraoral route; distinguish it from procedures that require osteotomy, address a different jaw, or remove bone for another indication. The operative report should describe the lesion and approach, the removal performed, and any relevant pathology. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery; 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.
How North Carolina compares for 21040
Across 109 of 109 payment localities, the office rate for 21040 runs from $428.07 in Arkansas to $621.15 in San Benito County, CA. North Carolina pays $452.74. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Carolina · this page$452.74
- Los Angeles, CA · California$534.86+$82.12
- Washington, DC area · District of Columbia$544.29+$91.55
- Miami, FL · Florida$522.41+$69.67
- Chicago, IL · Illinois$508.11+$55.37
- Manhattan, NY · New York$550.40+$97.66
- Alaska · Alaska$570.64+$117.90
Other areas in North Carolina first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $433.88 | $309.38 |
| ArkansasArkansas | $428.07 | $305.85 |
| ArizonaArizona | $467.82 | $329.95 |
| Bakersfield, CACalifornia | $504.13 | $348.18 |
| Chico, CACalifornia | $502.37 | $346.43 |
| El Centro, CACalifornia | $502.47 | $346.52 |
| Fresno, CACalifornia | $502.37 | $346.43 |
| Hanford, CACalifornia | $502.37 | $346.43 |
| Madera, CACalifornia | $502.37 | $346.43 |
| Merced, CACalifornia | $502.37 | $346.43 |
| Modesto, CACalifornia | $502.37 | $346.43 |
| Napa, CACalifornia | $575.84 | $388.31 |
| Oxnard, CACalifornia | $531.67 | $363.49 |
| Redding, CACalifornia | $502.37 | $346.43 |
| Rest of CaliforniaCalifornia | $502.37 | $346.43 |
| Riverside, CACalifornia | $508.78 | $352.83 |
| Sacramento, CACalifornia | $525.53 | $360.05 |
| Salinas, CACalifornia | $523.53 | $358.62 |
| San Diego, CACalifornia | $534.60 | $364.42 |
| Marin County, CACalifornia | $607.62 | $407.00 |
| San Francisco, CACalifornia | $606.95 | $406.33 |
| San Benito County, CACalifornia | $621.15 | $415.97 |
| Santa Clara County, CACalifornia | $618.41 | $413.23 |
| San Luis Obispo, CACalifornia | $515.29 | $353.22 |
| Santa Cruz, CACalifornia | $538.75 | $365.87 |
| Santa Maria, CACalifornia | $525.15 | $359.24 |
| Santa Rosa, CACalifornia | $544.09 | $369.36 |
| Stockton, CACalifornia | $502.37 | $346.43 |
| Vallejo, CACalifornia | $574.88 | $387.34 |
| Visalia, CACalifornia | $502.37 | $346.43 |
| Yuba City, CACalifornia | $502.37 | $346.43 |
| ColoradoColorado | $496.79 | $345.40 |
| ConnecticutConnecticut | $510.43 | $357.19 |
| DelawareDelaware | $475.18 | $334.60 |
| Fort Lauderdale, FLFlorida | $499.80 | $355.66 |
| Rest of FloridaFlorida | $476.67 | $340.64 |
| Atlanta, GAGeorgia | $489.22 | $344.65 |
| Rest of GeorgiaGeorgia | $451.32 | $324.40 |
| Hawaii, Guam, HIHawaii | $512.81 | $351.03 |
| IowaIowa | $442.56 | $312.37 |
| IdahoIdaho | $445.56 | $314.66 |
| East St. Louis, ILIllinois | $475.93 | $345.03 |
| Rest of IllinoisIllinois | $464.94 | $335.03 |
| Suburban Chicago, ILIllinois | $504.41 | $358.28 |
| IndianaIndiana | $447.92 | $316.02 |
| KansasKansas | $441.37 | $312.74 |
| KentuckyKentucky | $444.97 | $318.47 |
| New Orleans, LALouisiana | $464.93 | $331.04 |
| Rest of LouisianaLouisiana | $444.61 | $318.69 |
| Metropolitan Boston, MAMassachusetts | $542.62 | $372.72 |
| Rest of MassachusettsMassachusetts | $494.44 | $344.62 |
| Baltimore area, MDMaryland | $509.12 | $356.45 |
| Rest of MarylandMaryland | $483.56 | $339.56 |
| Rest of MaineMaine | $448.50 | $317.60 |
| Southern Maine, MEMaine | $470.00 | $328.99 |
| Detroit, MIMichigan | $482.98 | $345.67 |
| Rest of MichiganMichigan | $456.39 | $326.48 |
| MinnesotaMinnesota | $474.81 | $328.39 |
| Metropolitan Kansas City, MOMissouri | $461.20 | $327.59 |
| Metropolitan St. Louis, MOMissouri | $465.60 | $330.14 |
| Rest of MissouriMissouri | $438.02 | $315.37 |
| MississippiMississippi | $433.09 | $310.58 |
| MontanaMontana | $479.93 | $337.64 |
| North DakotaNorth Dakota | $468.27 | $325.98 |
| NebraskaNebraska | $444.59 | $313.26 |
| New HampshireNew Hampshire | $489.82 | $341.70 |
| Northern New JerseyNew Jersey | $539.43 | $374.38 |
| Rest of New JerseyNew Jersey | $515.91 | $360.53 |
| New MexicoNew Mexico | $459.01 | $328.53 |
| NevadaNevada | $476.98 | $334.55 |
| NYC suburbs and Long Island, NYNew York | $563.85 | $394.67 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $519.83 | $364.03 |
| Queens, NYNew York | $553.57 | $385.39 |
| Rest of New YorkNew York | $459.10 | $323.93 |
| OhioOhio | $454.00 | $324.10 |
| OklahomaOklahoma | $443.45 | $316.38 |
| Portland, OROregon | $510.82 | $352.73 |
| Rest of OregonOregon | $472.92 | $331.20 |
| Metropolitan Philadelphia, PAPennsylvania | $498.97 | $350.84 |
| Rest of PennsylvaniaPennsylvania | $454.26 | $323.64 |
| Puerto RicoPuerto Rico | $482.98 | $339.13 |
| Rhode IslandRhode Island | $490.79 | $343.81 |
| South CarolinaSouth Carolina | $454.19 | $322.72 |
| South DakotaSouth Dakota | $466.89 | $324.60 |
| TennesseeTennessee | $443.52 | $314.18 |
| Austin, TXTexas | $495.46 | $344.92 |
| Beaumont, TXTexas | $451.55 | $322.07 |
| Brazoria, TXTexas | $474.21 | $333.21 |
| Dallas, TXTexas | $477.41 | $335.69 |
| Fort Worth, TXTexas | $474.66 | $334.37 |
| Galveston, TXTexas | $475.76 | $334.47 |
| Houston, TXTexas | $486.56 | $345.27 |
| Rest of TexasTexas | $462.75 | $327.71 |
| UtahUtah | $459.94 | $326.19 |
| VirginiaVirginia | $469.07 | $329.20 |
| Virgin Islands, VIUnited States Virgin Islands | $482.98 | $339.13 |
| VermontVermont | $467.23 | $326.37 |
| Rest of WashingtonWashington | $493.26 | $343.43 |
| King County, WAWashington | $552.53 | $377.94 |
| WisconsinWisconsin | $453.72 | $317.41 |
| West VirginiaWest Virginia | $449.13 | $325.48 |
| WyomingWyoming | $474.85 | $332.56 |
21040 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$428.07
$570.64
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $570.64 | 1 |
| AL | $433.88 | 1 |
| AR | $428.07 | 1 |
| AZ | $467.82 | 1 |
| CA | $502.37–$621.15 | 29 |
| CO | $496.79 | 1 |
| CT | $510.43 | 1 |
| DC | $544.29 | 1 |
| DE | $475.18 | 1 |
| FL | $476.67–$522.41 | 3 |
| GA | $451.32–$489.22 | 2 |
| GU | $512.81 | 1 |
| HI | $512.81 | 1 |
| IA | $442.56 | 1 |
| ID | $445.56 | 1 |
| IL | $464.94–$508.11 | 4 |
| IN | $447.92 | 1 |
| KS | $441.37 | 1 |
| KY | $444.97 | 1 |
| LA | $444.61–$464.93 | 2 |
| MA | $494.44–$542.62 | 2 |
| MD | $483.56–$544.29 | 3 |
| ME | $448.50–$470.00 | 2 |
| MI | $456.39–$482.98 | 2 |
| MN | $474.81 | 1 |
| MO | $438.02–$465.60 | 3 |
| MS | $433.09 | 1 |
| MT | $479.93 | 1 |
| NC | $452.74 | 1 |
| ND | $468.27 | 1 |
| NE | $444.59 | 1 |
| NH | $489.82 | 1 |
| NJ | $515.91–$539.43 | 2 |
| NM | $459.01 | 1 |
| NV | $476.98 | 1 |
| NY | $459.10–$563.85 | 5 |
| OH | $454.00 | 1 |
| OK | $443.45 | 1 |
| OR | $472.92–$510.82 | 2 |
| PA | $454.26–$498.97 | 2 |
| PR | $482.98 | 1 |
| RI | $490.79 | 1 |
| SC | $454.19 | 1 |
| SD | $466.89 | 1 |
| TN | $443.52 | 1 |
| TX | $451.55–$495.46 | 8 |
| UT | $459.94 | 1 |
| VA | $469.07–$544.29 | 2 |
| VI | $482.98 | 1 |
| VT | $467.23 | 1 |
| WA | $493.26–$552.53 | 2 |
| WI | $453.72 | 1 |
| WV | $449.13 | 1 |
| WY | $474.85 | 1 |
How the 21040 rate is calculated
Each of 21040’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 · 21040
RVUs × geographic indexes × conversion factor
Work4.79
4.79 RVUs× 1.000 GPCI
Practice expense8.99
8.99 RVUs× 1.000 GPCI
Malpractice0.59
0.59 RVUs× 1.000 GPCI
Adjusted RVUs
14.3700
Conversion factor
$33.4009
Medicare rate
$479.97
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact North Carolina inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,850
- Code
- 21040
- Physician work
- 4.79
- Practice expense
- 8.99
- Malpractice
- 0.59
GPCI2026.csv
83
- Locality
- North Carolina
- Physician work
- 1.000
- Practice expense
- 0.933
- Malpractice
- 0.639
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.79 | × 1.000 | 4.7900 |
| Practice expense | 8.99 | × 0.933 | 8.3877 |
| Malpractice | 0.59 | × 0.639 | 0.3770 |
| Total RVUs | 13.5547 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Carolina$452.74
Office: (4.79 × 1 + 8.99 × 0.933 + 0.59 × 0.639) × $33.4009 = $452.74
Facility: (4.79 × 1 + 4.73 × 0.933 + 0.59 × 0.639) × $33.4009 = $319.98
Payment rules and modifiers for 21040
21040 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21040
Mandibular lesion excision, intraoral approach
| 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) | 1 | Not paid (statutory restriction). |
| 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) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21040
Mandibular lesion excision, intraoral approach
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
21040 without 51 · national office
$479.97
Mandibular lesion excision, intraoral approach
21040-51 · Second procedure: 50%
$239.99
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%).
How 21040 has changed in North Carolina
21040 · Office / nonfacility
$452.74
Effective 2026-10-01
The base rate is $25.27 higher than on 2025-10-01, moving from $427.47 to $452.74 (5.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$427.47changed to$452.74
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 4.91 changed to 4.79
- Practice expense RVU 8.61 changed to 8.99
- Malpractice RVU 0.50 changed to 0.59
- Practice expense GPCI 0.926 changed to 0.933
- Malpractice GPCI 0.665 changed to 0.639
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$436.69changed to$427.47
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 8.52 changed to 8.61
- Malpractice RVU 0.48 changed to 0.50
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$429.56changed to$436.69
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$447.29changed to$429.56
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 8.55 changed to 8.52
- Malpractice RVU 0.49 changed to 0.48
- Practice expense GPCI 0.927 changed to 0.926
- Malpractice GPCI 0.742 changed to 0.665
January 1, 2023
RVU23A
$457.61changed to$447.29
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 8.57 changed to 8.55
- Malpractice RVU 0.44 changed to 0.49
- Practice expense GPCI 0.928 changed to 0.927
- Malpractice GPCI 0.819 changed to 0.742
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$472.05changed to$457.61
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 8.89 changed to 8.57
- Malpractice RVU 0.45 changed to 0.44
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$485.46changed to$472.05
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 8.81 changed to 8.89
- Malpractice RVU 0.46 changed to 0.45
- Practice expense GPCI 0.930 changed to 0.928
- Malpractice GPCI 0.757 changed to 0.819
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$499.80changed to$485.46
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 9.01 changed to 8.81
- Malpractice RVU 0.82 changed to 0.46
- Practice expense GPCI 0.931 changed to 0.930
- Malpractice GPCI 0.695 changed to 0.757
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$506.62changed to$499.80
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 9.23 changed to 9.01
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$509.49changed to$506.62
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 9.33 changed to 9.23
- Malpractice GPCI 0.732 changed to 0.695
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$510.96changed to$509.49
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 9.38 changed to 9.33
- Malpractice RVU 0.83 changed to 0.82
- Practice expense GPCI 0.930 changed to 0.931
- Malpractice GPCI 0.768 changed to 0.732
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$512.53changed to$510.96
- Conversion factor 35.9335 changed to 35.8043
- Malpractice RVU 0.82 changed to 0.83
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$509.98changed to$512.53
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$506.93changed to$509.98
- Conversion factor 35.8228 changed to 35.7547
- Malpractice RVU 0.72 changed to 0.82
- Practice expense GPCI 0.929 changed to 0.930
- Malpractice GPCI 0.732 changed to 0.768
Held through RVU15B.
January 1, 2014
RVU14A
$504.28changed to$506.93
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 10.13 changed to 9.38
- Malpractice RVU 0.75 changed to 0.72
- Practice expense GPCI 0.927 changed to 0.929
- Malpractice GPCI 0.695 changed to 0.732
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $504.28
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $452.74 | $319.98 | RVU26D |
| 2026-07-01 | $452.74 | $319.98 | RVU26C |
| 2026-04-01 | $452.74 | $319.98 | RVU26B |
| 2026-01-01 | $452.74 | $319.98 | RVU26A |
| 2025-10-01 | $427.47 | $338.81 | RVU25D |
| 2025-07-01 | $427.47 | $338.81 | RVU25C |
| 2025-04-01 | $427.47 | $338.81 | RVU25B |
| 2025-01-01 | $427.47 | $338.81 | RVU25A |
| 2024-10-01 | $436.69 | $343.29 | RVU24D |
| 2024-07-01 | $436.69 | $343.29 | RVU24C |
| 2024-04-01 | $436.69 | $343.29 | RVU24B |
| 2024-03-09 | $436.69 | $343.29 | RVU24AR |
| 2024-01-01 | $429.56 | $337.69 | RVU24A |
| 2023-10-01 | $447.29 | $350.22 | RVU23D |
| 2023-07-01 | $447.29 | $350.22 | RVU23C |
| 2023-04-01 | $447.29 | $350.22 | RVU23B |
| 2023-01-01 | $447.29 | $350.22 | RVU23A |
| 2022-10-01 | $457.61 | $355.81 | RVU22D |
| 2022-07-01 | $457.61 | $355.81 | RVU22C |
| 2022-04-01 | $457.61 | $355.81 | RVU22B |
| 2022-01-01 | $457.61 | $355.81 | RVU22A |
| 2021-10-01 | $472.05 | $365.52 | RVU21D |
| 2021-07-01 | $472.05 | $365.52 | RVU21C |
| 2021-04-01 | $472.05 | $365.52 | RVU21B |
| 2021-01-01 | $472.05 | $365.52 | RVU21A |
| 2020-10-01 | $485.46 | $383.76 | RVU20D |
| 2020-07-01 | $485.46 | $383.76 | RVU20C |
| 2020-04-01 | $485.46 | $383.76 | RVU20B |
| 2020-01-01 | $485.46 | $383.76 | RVU20A |
| 2019-10-01 | $499.80 | $398.81 | RVU19D |
| 2019-07-01 | $499.80 | $398.81 | RVU19C |
| 2019-04-01 | $499.80 | $398.81 | RVU19B |
| 2019-01-01 | $499.80 | $398.81 | RVU19A |
| 2018-10-01 | $506.62 | $407.42 | RVU18D |
| 2018-07-01 | $506.62 | $407.42 | RVU18C |
| 2018-04-01 | $506.62 | $407.42 | RVU18B |
| 2018-01-01 | $506.62 | $407.42 | RVU18AR1 |
| 2017-10-01 | $509.49 | $410.93 | RVU17D |
| 2017-07-01 | $509.49 | $410.93 | RVU17C |
| 2017-04-01 | $509.49 | $410.93 | RVU17B |
| 2017-01-01 | $509.49 | $410.93 | RVU17A |
| 2016-10-01 | $510.96 | $412.73 | RVU16D |
| 2016-07-01 | $510.96 | $412.73 | RVU16C |
| 2016-04-01 | $510.96 | $412.73 | RVU16B |
| 2016-01-01 | $510.96 | $412.73 | RVU16A |
| 2015-10-01 | $512.53 | $413.27 | RVU15D |
| 2015-07-01 | $512.53 | $413.27 | RVU15C |
| 2015-04-01 | $509.98 | $411.22 | RVU15B |
| 2015-01-01 | $509.98 | $411.22 | RVU15A |
| 2014-10-01 | $506.93 | $409.09 | RVU14D |
| 2014-07-01 | $506.93 | $409.09 | RVU14C |
| 2014-04-01 | $506.93 | $409.09 | RVU14B |
| 2014-01-01 | $506.93 | $409.09 | RVU14A |
| 2013-10-01 | $504.28 | $402.72 | RVU13D |
| 2013-07-01 | $504.28 | $402.72 | RVU13C |
| 2013-04-01 | $504.28 | $402.72 | RVU13B |
| 2013-01-01 | $504.28 | $402.72 | RVU13AR |
Where the North Carolina rate applies
North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Advance
- Ahoskie
- Alamance
- Albemarle
- Alexis
- Alliance
- Altamahaw
21040 billing questions
How is 21040 different from 21046?
21040 is for intraoral removal of a benign mandibular lesion without the osteotomy described for 21046. Report 21046 when the documented procedure requires that intraoral osteotomy.
Can 21040 be reported for a malignant mandibular lesion?
No. This code is for a benign lesion; a malignant mandibular tumor requires the code that describes the applicable malignant-tumor procedure.
What documentation supports 21040?
Document the mandibular location, benign lesion or cyst diagnosis, intraoral approach, and the removal performed. Include pathology findings when available.
Should modifier 50 be used for lesions on both sides?
No. The CMS bilateral adjustment is not appropriate for this code, so do not report it with modifier 50.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the surgical global package.
Can an assistant or co-surgeon be paid for this procedure?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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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