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CPT code 21040: Mandibular lesion excision, intraoral approach2026 Medicare rate & RVUs in Puerto Rico

Reports intraoral removal of a benign lesion of the mandible when the procedure requires more than routine dental extraction or simple cyst care.

CMS RVU26DEffective Oct 1, 2026One payment locality1.3K Medicare services in 2024

In Puerto Rico, Medicare pays $482.98 for 21040 in the office and $339.13 when it’s performed in a hospital or facility.

$482.98Office (non-facility)
$339.13Hospital or facility
+0.6%vs the national office rate ($479.97)

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.

We’ll open 21040 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 21040 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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 Puerto Rico 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. Puerto Rico pays $482.98. The RVUs are the same everywhere; the geographic indexes change the dollars.

21040 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$482.98
  2. Los Angeles, CA · California$534.86+$51.88
  3. Washington, DC area · District of Columbia$544.29+$61.31
  4. Miami, FL · Florida$522.41+$39.43
  5. Chicago, IL · Illinois$508.11+$25.13
  6. Manhattan, NY · New York$550.40+$67.42
  7. Alaska · Alaska$570.64+$87.66

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

21040 in every other Medicare payment locality
Payment localityOfficeFacility
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

21040 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
21040 office rate range by state
State / territoryOffice rate rangeLocalities
AK$570.641
AL$433.881
AR$428.071
AZ$467.821
CA$502.37–$621.1529
CO$496.791
CT$510.431
DC$544.291
DE$475.181
FL$476.67–$522.413
GA$451.32–$489.222
GU$512.811
HI$512.811
IA$442.561
ID$445.561
IL$464.94–$508.114
IN$447.921
KS$441.371
KY$444.971
LA$444.61–$464.932
MA$494.44–$542.622
MD$483.56–$544.293
ME$448.50–$470.002
MI$456.39–$482.982
MN$474.811
MO$438.02–$465.603
MS$433.091
MT$479.931
NC$452.741
ND$468.271
NE$444.591
NH$489.821
NJ$515.91–$539.432
NM$459.011
NV$476.981
NY$459.10–$563.855
OH$454.001
OK$443.451
OR$472.92–$510.822
PA$454.26–$498.972
PR$482.981
RI$490.791
SC$454.191
SD$466.891
TN$443.521
TX$451.55–$495.468
UT$459.941
VA$469.07–$544.292
VI$482.981
VT$467.231
WA$493.26–$552.532
WI$453.721
WV$449.131
WY$474.851

See 21040 in every payment locality

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

Office or facility?

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 21040 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work4.79× 1.0004.7900
Practice expense8.99× 1.0119.0889
Malpractice0.59× 0.9850.5811
Total RVUs14.4600
Conversion factor× 33.4009

Office rate, Puerto Rico$482.98

Office: (4.79 × 1 + 8.99 × 1.011 + 0.59 × 0.985) × $33.4009 = $482.98

Facility: (4.79 × 1 + 4.73 × 1.011 + 0.59 × 0.985) × $33.4009 = $339.13

Open 21040 in the RVU calculator

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

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share 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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

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%).

When to use modifier 51

Codes related to 21040

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 21040
CodeHow it relatesOffice range, Puerto Rico
Same family
21046Mandibular lesion excision, intraoral osteotomy requiredBenign mandibular lesion removal requiring an intraoral osteotomy.No office rate
21047Jaw cyst excision, lower jaw, intraoral approachBenign mandibular lesion removal requiring an extraoral osteotomy.No office rate
Used instead
21030Bone lesion excision, maxilla or zygoma, benignBenign tumor or cyst removal from the maxilla rather than the mandible.$478.93
21044Jaw tumor excision, mandible, intraoral approachFor a malignant mandibular tumor rather than a benign lesion.No office rate
21031Exostosis removal, mandibleRemoval of a mandibular exostosis rather than a tumor or cyst.$392.18

How 21040 has changed in Puerto Rico

21040 · Office / nonfacility

$482.98

Effective 2026-10-01

The base rate is $27.82 higher than on 2025-10-01, moving from $455.16 to $482.98 (6.1%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $455.16changed to$482.98

    • 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 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $464.73changed to$455.16

    • 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.

  3. March 9, 2024

    RVU24AR

    $457.14changed to$464.73

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $474.78changed to$457.14

    • 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 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $472.73changed to$474.78

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $483.88changed to$472.73

    • 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 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $499.49changed to$483.88

    • 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.

  8. January 1, 2021

    RVU21A

    $514.09changed to$499.49

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $533.19changed to$514.09

    • 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 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $540.58changed to$533.19

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 9.23 changed to 9.01

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $481.73changed to$540.58

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.33 changed to 9.23
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $421.28changed to$481.73

    • 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 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $422.69changed to$421.28

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.82 changed to 0.83

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $420.59changed to$422.69

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $415.40changed to$420.59

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.72 changed to 0.82
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $407.08changed to$415.40

    • 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 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $407.08

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$482.98$339.13RVU26D
2026-07-01$482.98$339.13RVU26C
2026-04-01$482.98$339.13RVU26B
2026-01-01$482.98$339.13RVU26A
2025-10-01$455.16$358.74RVU25D
2025-07-01$455.16$358.74RVU25C
2025-04-01$455.16$358.74RVU25B
2025-01-01$455.16$358.74RVU25A
2024-10-01$464.73$363.16RVU24D
2024-07-01$464.73$363.16RVU24C
2024-04-01$464.73$363.16RVU24B
2024-03-09$464.73$363.16RVU24AR
2024-01-01$457.14$357.23RVU24A
2023-10-01$474.78$369.23RVU23D
2023-07-01$472.73$368.01RVU23C
2023-04-01$472.73$368.01RVU23B
2023-01-01$472.73$368.01RVU23A
2022-10-01$483.88$373.30RVU22D
2022-07-01$483.88$373.30RVU22C
2022-04-01$483.88$373.30RVU22B
2022-01-01$483.88$373.30RVU22A
2021-10-01$499.49$383.77RVU21D
2021-07-01$499.49$383.77RVU21C
2021-04-01$499.49$383.77RVU21B
2021-01-01$499.49$383.77RVU21A
2020-10-01$514.09$403.87RVU20D
2020-07-01$514.09$403.87RVU20C
2020-04-01$514.09$403.87RVU20B
2020-01-01$514.09$403.87RVU20A
2019-10-01$533.19$423.96RVU19D
2019-07-01$533.19$423.96RVU19C
2019-04-01$533.19$423.96RVU19B
2019-01-01$533.19$423.96RVU19A
2018-10-01$540.58$433.28RVU18D
2018-07-01$540.58$433.28RVU18C
2018-04-01$540.58$433.28RVU18B
2018-01-01$540.58$433.28RVU18AR1
2017-10-01$481.73$391.11RVU17D
2017-07-01$481.73$391.11RVU17C
2017-04-01$481.73$391.11RVU17B
2017-01-01$481.73$391.11RVU17A
2016-10-01$421.28$346.81RVU16D
2016-07-01$421.28$346.81RVU16C
2016-04-01$421.28$346.81RVU16B
2016-01-01$421.28$346.81RVU16A
2015-10-01$422.69$347.45RVU15D
2015-07-01$422.69$347.45RVU15C
2015-04-01$420.59$345.72RVU15B
2015-01-01$420.59$345.72RVU15A
2014-10-01$415.40$342.52RVU14D
2014-07-01$415.40$342.52RVU14C
2014-04-01$415.40$342.52RVU14B
2014-01-01$415.40$342.52RVU14A
2013-10-01$407.08$332.80RVU13D
2013-07-01$407.08$332.80RVU13C
2013-04-01$407.08$332.80RVU13B
2013-01-01$407.08$332.80RVU13AR

Price 21040 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 21040PPRRVU2026_Oct_nonQPP.csv, line 1,850 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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