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CPT code 40490: Lip biopsy, lip tissue2026 Medicare rate & RVUs in Santa Clara County, CA

Reports a biopsy of lip tissue to obtain a specimen from a suspicious lip lesion for diagnostic examination.

CMS RVU26DEffective Oct 1, 2026One payment locality26.4K Medicare services in 2024

In Santa Clara County, CA, Medicare pays $156.01 for 40490 in the office and $63.53 when it’s performed in a hospital or facility.

$156.01Office (non-facility)
$63.53Hospital or facility
+29.7%vs the national office rate ($120.24)

Check a contract rate as a % of Medicare · 40490 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 40490 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Santa Clara County, CA
  2. What 40490 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 40490 covers

A clinician removes a tissue sample from a lip lesion for diagnostic evaluation. This service is commonly performed by dermatologists, otolaryngologists, oral surgeons, and other clinicians who evaluate lip abnormalities in an office or facility setting. The target must be on the lip; a lesion elsewhere in the mouth has a site-specific biopsy code. A biopsy obtains a diagnostic sample rather than removing a lesion as definitive treatment.

Select the code from the documented biopsy site and procedure, and retain the operative note describing the lip location, lesion, and tissue sampled. The specimen may be sent for separate pathology evaluation. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. CMS does not pay for an assistant at surgery, co-surgeons, or team surgery for this service.

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 Santa Clara County, CA compares for 40490

Across 109 of 109 payment localities, the office rate for 40490 runs from $107.51 in Arkansas to $156.56 in San Benito County, CA. Santa Clara County, CA pays $156.01. The RVUs are the same everywhere; the geographic indexes change the dollars.

40490 in Santa Clara County, CA vs other payment areas
  1. Santa Clara County, CA · this page$156.01
  2. Bakersfield, CA · California$126.77−$29.24
  3. Chico, CA · California$126.40−$29.61
  4. El Centro, CA · California$126.42−$29.59
  5. Fresno, CA · California$126.40−$29.61
  6. Hanford, CA · California$126.40−$29.61
  7. Los Angeles, CA · California$134.52−$21.49

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

Every other payment area

40490 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia$126.40$56.12
Merced, CACalifornia$126.40$56.12
Modesto, CACalifornia$126.40$56.12
Napa, CACalifornia$145.10$60.58
Oxnard, CACalifornia$133.77$57.96
Redding, CACalifornia$126.40$56.12
Rest of CaliforniaCalifornia$126.40$56.12
Riverside, CACalifornia$127.71$57.43

40490 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.

$107.51

$143.29

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
40490 office rate range by state
State / territoryOffice rate rangeLocalities
AK$143.291
AL$108.941
AR$107.511
AZ$117.291
CA$126.40–$156.5629
CO$124.741
CT$127.771
DC$136.461
DE$119.121
FL$118.89–$129.513
GA$112.75–$122.392
GU$129.031
HI$129.031
IA$111.321
ID$112.011
IL$115.85–$126.094
IN$112.601
KS$110.911
KY$111.411
LA$111.28–$116.282
MA$124.12–$136.272
MD$121.23–$136.463
ME$112.61–$118.082
MI$114.11–$120.322
MN$119.641
MO$109.58–$116.583
MS$108.571
MT$120.241
NC$113.671
ND$117.861
NE$111.861
NH$122.881
NJ$129.26–$135.262
NM$114.701
NV$119.651
NY$115.23–$140.685
OH$113.621
OK$111.171
OR$118.75–$128.342
PA$113.75–$124.872
PR$121.021
RI$123.091
SC$113.831
SD$117.581
TN$111.431
TX$113.07–$124.308
UT$115.251
VA$117.76–$136.462
VI$121.021
VT$117.501
WA$123.86–$138.862
WI$114.261
WV$111.951
WY$119.201

See 40490 in every payment locality

How the 40490 rate is calculated

Each of 40490’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 · 40490

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.19

1.19 RVUs× 1.000 GPCI

Practice expense2.29

2.29 RVUs× 1.000 GPCI

Malpractice0.12

0.12 RVUs× 1.000 GPCI

Adjusted RVUs

3.6000

Conversion factor

$33.4009

Medicare rate

$120.24

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Santa Clara County, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,819

Code
40490
Physician work
1.19
Practice expense
2.29
Malpractice
0.12

GPCI2026.csv

28

Locality
Santa Clara County, CA
Physician work
1.110
Practice expense
1.442
Malpractice
0.397
Office calculation for 40490 in Santa Clara County, CA
ComponentRVULocality factorAdjusted
Physician work1.19× 1.1101.3209
Practice expense2.29× 1.4423.3022
Malpractice0.12× 0.3970.0476
Total RVUs4.6707
Conversion factor× 33.4009

Office rate, Santa Clara County, CA$156.01

Office: (1.19 × 1.11 + 2.29 × 1.442 + 0.12 × 0.397) × $33.4009 = $156.01

Facility: (1.19 × 1.11 + 0.37 × 1.442 + 0.12 × 0.397) × $33.4009 = $63.53

Open 40490 in the RVU calculator

Payment rules and modifiers for 40490

The CMS indicators that decide how 40490 is paid alongside other services.

CMS payment indicators · 40490

Lip biopsy, lip tissue

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

40490 without 51 · national office

$120.24

Lip biopsy, lip tissue

40490-51 · Second procedure: 50%

$60.12

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 40490

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

Codes related to 40490
CodeHow it relatesOffice range, Santa Clara County, CA
Used instead
40808Mouth biopsy, oral vestibuleBiopsy code for a lesion in the vestibule of the mouth rather than on the lip.$226.07
41100Tongue biopsy, anterior two-thirdsUse for a biopsy when the sampled lesion is on the tongue.$249.23
41108Oral biopsy, floor of mouthUse for a biopsy when the sampled lesion is in the floor of the mouth.$228.05
42100Palate biopsy, tissue samplingUse for a biopsy when the sampled lesion is on the palate.$195.23
11104Punch biopsy, single skin lesionMay apply to a punch biopsy of a skin lesion outside the lip.$162.71

How 40490 has changed in Santa Clara County, CA

40490 · Office / nonfacility

$156.01

Effective 2026-10-01

The base rate is $3.61 higher than on 2025-10-01, moving from $152.40 to $156.01 (2.4%).

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

    $152.40changed to$156.01

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.22 changed to 1.19
    • Practice expense RVU 2.31 changed to 2.29
    • Malpractice RVU 0.13 changed to 0.12
    • Work GPCI 1.100 changed to 1.110
    • Practice expense GPCI 1.435 changed to 1.442
    • Malpractice GPCI 0.420 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $157.79changed to$152.40

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.33 changed to 2.31

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $155.21changed to$157.79

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $158.82changed to$155.21

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.34 changed to 2.33
    • Malpractice RVU 0.12 changed to 0.13
    • Work GPCI 1.098 changed to 1.100
    • Practice expense GPCI 1.409 changed to 1.435
    • Malpractice GPCI 0.417 changed to 0.420

  5. January 1, 2023

    RVU23A

    $158.88changed to$158.82

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.32 changed to 2.34
    • Malpractice RVU 0.11 changed to 0.12
    • Work GPCI 1.096 changed to 1.098
    • Practice expense GPCI 1.383 changed to 1.409
    • Malpractice GPCI 0.414 changed to 0.417

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $161.46changed to$158.88

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.34 changed to 2.32
    • Malpractice RVU 0.13 changed to 0.11

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $159.22changed to$161.46

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.22 changed to 2.34
    • Malpractice RVU 0.11 changed to 0.13
    • Work GPCI 1.089 changed to 1.096
    • Practice expense GPCI 1.369 changed to 1.383
    • Malpractice GPCI 0.401 changed to 0.414

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $157.35changed to$159.22

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.20 changed to 2.22
    • Malpractice RVU 0.17 changed to 0.11
    • Work GPCI 1.083 changed to 1.089
    • Practice expense GPCI 1.354 changed to 1.369
    • Malpractice GPCI 0.388 changed to 0.401

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $161.56changed to$157.35

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.29 changed to 2.20

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $161.52changed to$161.56

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.30 changed to 2.29
    • Work GPCI 1.086 changed to 1.083
    • Practice expense GPCI 1.351 changed to 1.354
    • Malpractice GPCI 0.402 changed to 0.388

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $160.50changed to$161.52

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.29 changed to 2.30
    • Work GPCI 1.088 changed to 1.086
    • Practice expense GPCI 1.347 changed to 1.351
    • Malpractice GPCI 0.416 changed to 0.402

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $161.41changed to$160.50

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.30 changed to 2.29
    • Malpractice RVU 0.16 changed to 0.17

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $160.61changed to$161.41

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $157.37changed to$160.61

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.23 changed to 2.30
    • Malpractice RVU 0.17 changed to 0.16
    • Work GPCI 1.083 changed to 1.088
    • Practice expense GPCI 1.342 changed to 1.347
    • Malpractice GPCI 0.466 changed to 0.416

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $162.50changed to$157.37

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.52 changed to 2.23
    • Malpractice RVU 0.18 changed to 0.17
    • Work GPCI 1.077 changed to 1.083
    • Practice expense GPCI 1.337 changed to 1.342
    • Malpractice GPCI 0.516 changed to 0.466

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$162.50

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$156.01$63.53RVU26D
2026-07-01$156.01$63.53RVU26C
2026-04-01$156.01$63.53RVU26B
2026-01-01$156.01$63.53RVU26A
2025-10-01$152.40$79.06RVU25D
2025-07-01$152.40$79.06RVU25C
2025-04-01$152.40$79.06RVU25B
2025-01-01$152.40$79.06RVU25A
2024-10-01$157.79$80.40RVU24D
2024-07-01$157.79$80.40RVU24C
2024-04-01$157.79$80.40RVU24B
2024-03-09$157.79$80.40RVU24AR
2024-01-01$155.21$79.09RVU24A
2023-10-01$158.82$80.99RVU23D
2023-07-01$158.82$80.99RVU23C
2023-04-01$158.82$80.99RVU23B
2023-01-01$158.82$80.99RVU23A
2022-10-01$158.88$80.39RVU22D
2022-07-01$158.88$80.39RVU22C
2022-04-01$158.88$80.39RVU22B
2022-01-01$158.88$80.39RVU22A
2021-10-01$161.46$81.35RVU21D
2021-07-01$161.46$81.35RVU21C
2021-04-01$161.46$81.35RVU21B
2021-01-01$161.46$81.35RVU21A
2020-10-01$159.22$84.12RVU20D
2020-07-01$159.22$84.12RVU20C
2020-04-01$159.22$84.12RVU20B
2020-01-01$159.22$84.12RVU20A
2019-10-01$157.35$84.15RVU19D
2019-07-01$157.35$84.15RVU19C
2019-04-01$157.35$84.15RVU19B
2019-01-01$157.35$84.15RVU19A
2018-10-01$161.56$85.03RVU18D
2018-07-01$161.56$85.03RVU18C
2018-04-01$161.56$85.03RVU18B
2018-01-01$161.56$85.03RVU18AR1
2017-10-01$161.52$85.88RVU17D
2017-07-01$161.52$85.88RVU17C
2017-04-01$161.52$85.88RVU17B
2017-01-01$161.52$85.88RVU17A
2016-10-01$160.50$85.26RVU16D
2016-07-01$160.50$85.26RVU16C
2016-04-01$160.50$85.26RVU16B
2016-01-01$160.50$85.26RVU16A
2015-10-01$161.41$85.42RVU15D
2015-07-01$161.41$85.42RVU15C
2015-04-01$160.61$85.00RVU15B
2015-01-01$160.61$85.00RVU15A
2014-10-01$157.37$84.78RVU14D
2014-07-01$157.37$84.78RVU14C
2014-04-01$157.37$84.78RVU14B
2014-01-01$157.37$84.78RVU14A
2013-10-01$162.50$83.80RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 40490 for an earlier date of service

Where the Santa Clara County, CA rate applies

Santa Clara County, CA is a Medicare payment area, not a city. Our Census mapping connects it to 24 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • San Jose
  • Santa Clara
  • Sunnyvale
  • Alum Rock
  • Burbank
  • Cambrian Park
  • Campbell
  • Cupertino

Browse all communities in California

40490 billing questions

How is 40490 distinguished from a biopsy elsewhere in the mouth?

Use 40490 when the sampled tissue is on the lip. Biopsies of the tongue, floor of mouth, palate, or oral vestibule have site-specific codes.

Is 40490 a biopsy or an excision?

It reports obtaining a diagnostic tissue sample from the lip. If the procedure removes a lesion rather than sampling it for diagnosis, evaluate the applicable excision code instead.

Can modifier 50 be used when both lips are sampled?

No. CMS bilateral adjustment does not apply to 40490, and modifier 50 is inappropriate for this descriptor and anatomy.

What same-day care is included?

The 0-day global period includes the related preoperative and postoperative care furnished on the procedure date.

How does CMS handle 40490 with another procedure in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.

What documentation supports reporting 40490?

Document that the sampled lesion is on the lip, its location and clinical description, and the tissue obtained. Include the procedure details and specimen disposition.

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 40490PPRRVU2026_Oct_nonQPP.csv, line 4,819 (RVU26D)
Geographic factors for Santa Clara County, CAGPCI2026.csv, line 28 (RVU26D)

Open CMS sourceHow we calculate rates

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